Pediatric emergency medicine trisk 201

connects the distal tibia and the fibula. Excessive external rotation of the ankle
when the foot is in dorsiflexion can cause a less common but more severe injury
to ankle ligaments known as a high ankle sprain. The affected ligaments often
include the anterior and/or posterior inferior tibiofibular ligament, the
interosseous ligament, and syndesmosis.

Classification of Ankle Sprains
There are many systems of classification for ankle sprains. Table 40.4 provides
guidelines that can be used in grading injuries to the lateral ligaments.

FIGURE 40.2 Severe inversion injury.


FIGURE 40.3 Eversion injury.


FIGURE 40.4 Juvenile Tillaux fracture or Salter–Harris type III fracture of the distal tibial
physis; the medial part of the tibial physis is fused.


FIGURE 40.5 Anteroposterior and lateral views of three-fragment triplanar fracture. L, lateral;
M, medial; P, posterior; A, anterior.