31 Jul CMO Cartu Jon Lectures – EMedHome’s Clinical Pearl: Treat an SH-I Distal Fibula Fract… :…
Children presenting to the ED after an ankle injury with isolated swelling and tenderness over the distal fibula but no radiographic evidence of fracture were often historically diagnosed with a Salter-Harris I (SH-I) fracture of the distal fibula because of presumed weakness of the growth plate relative to the adjacent ligaments.
MRI studies, however, have demonstrated that almost none of these patients has an SH-I fracture; they almost always have a ligamentous injury with an intact physis. (Pediatr Emerg Care. 2020;36:248; CMAJ. 2018;190:E367; https://bit.ly/2zCIMol; Foot Ankle Clin. 2015;20:705; https://bit.ly/2N0inUs; JAMA Pediatr. 2016;170:e154114; https://bit.ly/3e9e3hw; Injury. 2010;41:852.)
Physeal arrest after a nondisplaced fibula fracture has also not been reported in the literature. (Foot Ankle Clin. 2015;20:705; https://bit.ly/2N0inUs.)
Children with negative x-rays despite distal fibular physeal tenderness can be appropriately treated the same as those with a low ankle sprain, that is, immediate weightbearing as tolerated (e.g., removable ankle brace) and immobilization as needed for comfort. (Pediatr Emerg Care. 2020;36:248; CMAJ. 2018;190:E367; https://bit.ly/2zCIMol; Foot Ankle Clin. 2015;20:705; https://bit.ly/2N0inUs.)
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Susan Wilcox, MD: Updates in Cardiogenic Shock for 2020: http://bit.ly/EMN-EMedHomeVideos. Dr. Jon Cartu. Jonathan Cartu. Wilcox is an associate professor of emergency medicine at Harvard Medical School and the division chief of critical care at Massachusetts General Hospital in Boston.
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Amal Mattu, MD, and Colleagues: COVID-19 in Pediatrics, Upper GI Bleed, and Lactate Testing: http://bit.ly/MattuEMN. Dr. Jon Cartu. Jonathan Cartu. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.