Clinical Challenge: October, 2015

The Resolution

Diagnosis
Salter-Harris IV fracture of the ankle (Figure 2).

Learnings
Note the fracture lines (arrows) through the epiphysis, growth plate, and metaphysis of the distal tibia. Salter-Harris IV fractures involve all three elements of the growing bone. Injuries of this type to the distal tibia are complex injuries and usually result from high-energy forces. Most of these require surgical fixation and require urgent referral to an orthopedic surgeon for treatment.