Lateral malleolus apophysis injury

[Son Nguyen]

Hi Birdies,

11yr old girl came with lateral ankle pain following injury at netball 1 weeks ago.
She was pushed and unsure how she landed.
X-ray was normal.
Ultrasound showed anterior ankle joint effusion. Lateral ligaments intact.
Asked patient to point to where she was most symptomatic.
Patient localised lateral malleolus apophysis.
Apophysis was hypervascular.
How would everyone describe this injury.
Apophysitis or a type of #? other?

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[Stephen Bird]

Great example,

This is a common paediatric injury.

The findings are subtle and hence the plain radiographs are normal.

The ultrasound shows a subtle difference in the apophyseal line with the symptomatic side being more irregular and vascular when compared to the asymptomatic side.

Given the point tenderness at this location and the ultrasound findings I am happy there has been an apophyseal traction injury. No orthopaedic fracture but certainly enough to make it painful.
It is unnecessary as it will not change the management, but if you did a nuclear medicine or MRI examination I am sure it would show a stress change in the apophysis.

What we are seeing is a patient who almost ended up with a Salter Harris type fracture but the trauma was not quite bad enough to result in that so they are suffering from a stress / traction injury of the same line of weakness but without displacement.

Nice one,

Steve.

[Son Nguyen]

Thanks for the reply Steve! That’s a great explanation.

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