Let’s Do the Twist

Ankle injuries are a common presentation to the pediatric emergency department, with ankle sprains significantly more common than ankle fractures. This chapter presents a child with a swollen, painful ankle after a sports injury. Evaluation of ankle injuries is discussed, including use of clinical decision rules such as the Ottawa Ankle Rules and the Low Risk Ankle Rule, which help determine who is at low risk for ankle fracture and may not need radiographic imaging. Classification of fractures in children with open physes using the Salter-Harris nomenclature is reviewed. Management of ankle injuries, including bracing, splinting, casting, need for urgent orthopedic consultation, follow-up, and healing are also discussed.