![]() In addition to this, the medial malleolus serves as a bony restraint to the medial translation of the talus within the tibiotalar joint. The medial malleolus serves as the attachment site for the deltoid ligament, which is composed of a superficial and deep portion. The lateral distal tibia also contains a groove for the fibula called the incisura. The AITFL attaches to the tillaux-Chaput tubercle, and the PITFL attaches to the posterior malleolus. The lateral distal tibia serves as an important attachment site for two of the syndesmotic ligaments: the anterior-inferior tibiofibular ligament (AITFL) and posterior-inferior tibiofibular ligament (PITFL). The distal tibia has a concave shape and therefore is congruent with the talar body/dome. As a result of this phased closure, there are unique adolescent ankle fractures such as the tillaux fracture and the triplane fracture. The physis closes in a predictable manner, first centrally, followed by medially, and finally laterally. The distal physis ossifies around the age of one year and typically fuses around the age of 18 to 20 years. The plafond is the actual weight-bearing portion that articulates with the talus below. The distal tibia has three distinct portions: the plafond, the lateral distal tibia, and the medial malleolus. The different acute conditions associated with the tibiotalar and subtalar joint make this clinically important. Oftentimes the subtalar joint, which is the articulation between the talus and the calcaneus, is included when discussing the ankle joint however, this is, technically, not a part of the ankle but, rather, the hindfoot. This is an important anatomical distinction as this is the true “ankle” joint. The distal tibia articulates with the distal fibula to form the distal tibiofibular articulation and the talus, forming the tibiotalar joint. The ankle joint is made up of the distal tibia, the distal fibula, and the talus. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting March 24-28, 2020 (meeting canceled).ĭisclosure: Beck reports she is a board or committee member of POSNA and of Pediatric Research in Sports Medicine.The ankle's anatomy can be broken down into osteology, musculature, and neurovascular structures. removable boot is currently underway to determine optimal treatment of these injuries.” – by Casey Tingleīeck J, et al. A POSNA-funded randomized study on the effect of cast vs. removable boot) may influence complication rate and patient satisfaction. “The most common complication related to treatment was cast related complications, indicating choice of immobilization (cast vs. “Although complications are rare from this injury, POSNA members do report complications such as late displacement, nonunion, growth arrest and most commonly chronic pain, possibly resulting in CRPS/RSD,” Beck told Healio Orthopedics. Results showed 81.2% of POSNA members reported no complications from Salter-Harris 1 distal fibula fracture treatment and 87.8% reported no complications from ankle sprain treatment among pediatric patients. Researchers noted growth arrest and continued pain/reflex sympathetic dystrophy as other reported ankle sprain complications. Results showed other reported complications with Salter-Harris 1 fractures included persistent pain/reflex sympathetic dystrophy, distal fibular growth arrest, infection, nonunion and recurrent fracture. Researchers noted 9.6% and 5.2% of respondents reported having seen a cast complication in Salter-Harris 1 distal fibula fracture treatment and ankle sprain treatment, respectively, compared with 0.4% reported having seen a brace complication in both Salter-Harris 1 fractures and ankle sprains. For ankle sprain treatment, 45% preferred the CAM boot, 18% preferred a stirrup brace, 14.5% preferred an over-the-counter brace and 11% preferred a cast, according to results. Researchers found 54% of respondents preferred controlled ankle movement (CAM) boot immobilization and 34% preferred cast immobilization for Salter-Harris 1 distal fibula fracture treatment. Of the 16.4% of POSNA members who completed the survey, results showed 81.2% reported no complications from Salter-Harris 1 distal fibula fracture treatment and 87.8% reported no complications from ankle sprain treatment. Beck, MD, and colleagues surveyed 1,400 members of the Pediatric Orthopaedic Society of North America to identify treatment complications and rare complications of ankle sprains and non-displaced Salter-Harris 1 distal fibula fractures in skeletally immature patients.
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