• Yoon-Hae Kwak, Jae-Young Lim, Min-Kyung Oh, Woo-Jin Kim, and Kun-Bo Park.
• *Department of Orthopaedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang Departments of †Orthopedic Surgery §Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine ‡Clinical Trial Center, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
• J Pediatr Orthop. 2015 Jun 1; 35 (4): 352-7.

BackgroundSkeletally immature children with ankle sprain are presumed to have distal fibula fracture than ligamentous injury. The purpose of this study is to determine the incidence of associated occult avulsion fracture in children with lateral ankle sprain and the efficacy of identifying fractures using anterior talofibular ligament view.MethodsPatients who were diagnosed with distal fibular fracture in the initial ankle anteroposterior, lateral, and mortise were excluded and 78 patients (below 16 y of age) who had been initially diagnosed as ankle sprain were included. The initial and 4 weeks' follow-up ankle series and additional anterior talofibular ligament view suggested by Haraguchi were evaluated.ResultsTwenty patients were diagnosed with occult distal fibular avulsion fracture. Ten patients were diagnosed in anterior talofibular ligament view and others were diagnosed in the follow-up radiography. Displacement was highest on the anterior talofibular ligament view.ConclusionsThis study found 20 (26%) of 78 ankle sprain show occult avulsion fracture in the anterior talofibular ligament view or follow-up radiography. The anterior talofibular ligament view is an appropriate radiologic view for the diagnosis of distal fibular avulsion fracture.Level Of EvidenceLevel IV--diagnostic study.

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