Adult & Pediatric Fracture Care

Fractures or broken bones are very common injuries in the lower extremity.  At Florida Orthopedic Foot & Ankle Center we are well trained and have treated hundreds of traumatic conditions of the lower extremity.  In all cases a detailed exam is performed and all treatment options are explained and offered to patients.  There are many fractures that can be treated

In some situations, a fracture may need to be stabilized temporarily with an external fixator in order to let the swelling reduce.  If one of these are used, they are usually in place for a week or two and then definitive surgery can be performed and the bones put back into proper alignment.  However, most of the time fractures can be fixed in one trip to the operating room once the swelling is reduced enough to safely perform the surgery.

This is a 40 year-old female who presented to the ER after a waterslide accident. She sustained a severe tibia and ankle fracture which was displaced.

She was immediately taken to the operating room and the fibula was fixed and a temporary external fixator was applied to let the soft tissue swelling to resolve.

X-ray of the reduced tibia fracture and the fibula which has been plated and brought out to anatomical position.

Definitive fixation of the fractures. The ankle joint has been restored anatomically.

This is a 78 year-old patient who fell at home. The ankle is broken in multiple areas and is dislocated.

Internal fixation was applied and the ankle joint is now in anatomic position.

Pediatric Fractures

Fractures in children can be caused by twisting of the ankle and/or foot which can cause the growth plate to fracture or even move out of position.  These types of injuries are common in sports especially football, soccer and basketball.  In addition, direct trauma or an injury to a growth plate, falling from a height and even an axial load are other common causes of these injuries.

Mild injuries that are low energy can cause a small degree of pain and swelling directly on the growth plate or the joint.  Weightbearing may be uncomfortable but tolerable.  Children may limp.  Moderate injuries can cause more pain, swelling and cause more difficulty weightbearing.  There would be a general avoidance of trying to put weight on the foot or ankle.  Severe injuries can cause pain, swelling, difficulty weightbearing, and the bone and joint may even appear out of place.

A thorough history and physical examination of the injured body part and surrounding joints, muscles, ligaments and bones is necessary.  X-rays may show the fracture in many cases.  However, in more simple injuries an x-ray may appear to be normal. When x-rays show no abnormality but pain is significant, an MRI may be ordered to better evaluate the bone, marrow and growth plate.  Salter I and Salter V fractures are often better visualized on MRIs.  When x-rays show a bone abnormality and there is displacement of the bone fragments and growth plates, a CT scan is a better imaging modality.  It helps to better guide treatment for the child or teenager.  CT scans are necessary to assess the position of the bone and growth plates and are used for pre-operative planning in those cases that need surgery.  In those cases that do require surgery, Dr. Cottom will often utilize an arthroscope to visualize the ankle joint and make sure the fracture is reduced perfectly.

This is a 14 year-old who sustained a growth plate fracture which involved the ankle joint.

Dr. Cottom performed an arthroscopic assisted repair of the fracture and growth plate. The scope allows direct visualization of the fracture which enters the joint. The advantage of this is that confirmation that the fracture is perfectly reduced can be confirmed with the scope.

This is a 16 year-old who fell while playing soccer and sustained a right ankle fracture with growth plate separation.

The CT scan better demonstrates the fracture in the tibia, involvement of the growth plate and ankle joint.

After open reduction and internal fixation of the fibula and tibia. The joint surface is reduced into anatomic position. Note, the plate on the fibula is just above the growth plate and the comminuted, displaced fibular fracture has been realigned.