[Differentiated protocol for the conservative/surgical treatment of ankle fractures in children].

Objective: Evaluation of the long-term results of protocolled treatment of ankle fractures in childhood.
Setting: St Elisabeth Hospital, Tilburg, the Netherlands.
Design: Retrospective long-term follow-up study.
Method: All 78 children with an ankle fracture and an open epiphyseal plate in the period 1985-1989 were treated according to a protocol which specified the indications for conservative or surgical therapy depending on the particular fracture type according to Salter and Harris. After a median follow-up period of 3.42 years (range: 2.08-7.67 years) in 48 patients the treatment results could be evaluated in 92% of these patients. Thirty patients had an isolated fracture of the distal part of the fibula.
Results: A clinically 'good' or 'excellent' result was achieved in 100% of the patients, and an 'excellent' result in 68%.
Conclusions: Growth disturbances after an ankle fracture in children with an open epiphyseal plate can now be restricted to the very rare fractures with severe damage to the germinative layer of the epiphyseal plate. In general, conservative treatment should be used in Salter and Harris I and II fractures and operative treatment in displaced Salter and Harris III and IV fractures.