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FIGURE 40.10 Evaluation and diagnosis of traumatic ankle injuries.

TREATMENT
Fractures
Fracture reduction is usually accomplished by reversing the mechanism of injury.
Closed reduction and cast immobilization may be appropriate for displaced
fractures; if reduction cannot be achieved or maintained with casting, open
reduction internal fixation may be necessary (see Chapter 111 Musculoskeletal
Trauma ). Some displacement can be accepted in younger patients because of
their ability to remodel. Two studies have suggested that children with
nondisplaced S-H type I, type II, and avulsion fractures of distal fibula may
benefit from less conservative therapy; those treated with crutches, a 5-day period
of nonweight bearing, and the use of a removable ankle brace (e.g., an air-stirrup
ankle brace or an elastic bandage) were able to return to normal activity sooner
than those in whom short leg casts were used. Patients in these studies advanced
their activities as tolerated. S-H type III and IV injuries involve the articular