Lower Extremity Fractures

Children break bones more easily than adults - so pediatric fractures are very common. There are several unique features of the pediatric musculoskeletal system that need to be considered in management decisions of all of these injuries - growth plates, plasticity, callus formation, remodeling potential, and partial breaks are some of the key ones. Recognition and appropriate management of pediatric fractures by ED providers is critical. While some common minor wrist and ankle fractures can be treated with a less conservative approach encouraging an early return to activities, other fractures if not treated properly can result in long term functional problems for the child and/or be a sign of child maltreatment.



Key studies

Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments


Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendo...

Objective: To examine the costs and consequences of implementing the Low Risk Ankle Rule.

Key Study: Altered lower extremity fracture characteristics in obese pediatric trauma patients


Gilbert, SR, MacLennan, PA, Backstrom, I, Creek, A & Sawyer, J

Objective: To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese versus nonobese pediatric trauma patients.

Key Study: Effect of the low risk ankle rule on the frequency of radiography in children with ankle injuries


Boutis, K, Grootendorst, P, Willan, A, Plint, AC, Babyn, P, Brison, RJ, Sayal...

Objective: To evaluate the effectivness of the Low Risk Ankle Rule in reducing the frequency of radiography in children with ankle injuries.

Key Study: Functional outcome after air-stirrup ankle brace or fiberglass backslab for pediatric low-risk ankle fractures: a randomized observer-blinded controlled trial


Barnett, PL, Lee, MH, Oh, L, Cull, G & Babl, F

Objective: To determine if the below-knee fiberglass posterior splint was as effective as the Air-Stirrup ankle brace in returning children with a low risk ankle fracture to their normal level of activity.

Key Study: Prospective validation and head-to-head comparison of 3 ankle rules in a pediatric population


Gravel, J, Hedrei, P, Grimard, G & Gouin, S

Objective: To determine the criterion validity of three rules for predicting clinically important ankle fractures in children.

Key Study: A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures


Boutis, K, Willan, AR, Babyn, P, Narayanan, UG, Alman, B & Schuh, S

Objective: To determine whether children who have low-risk ankle fractures that are treated with a removable ankle brace have at least as effective a recovery of physical function as those that are treated with a cast.

Key Study: Validation of the Ottawa Knee Rule in children: a multicenter study


Bulloch, B, Neto, G, Plint, A, Lim, R, Lidman, P, Reed, M, Nijssen-Jordan, C,...

Objectives: To determine the sensitivity and specificity of the Ottawa Knee Rules when they were applied to children, and to determine post hoc whether use of the rules would reduce the number of knee radiographs ordered.

Key Study: Validation of the Ottawa Ankle Rules in children with ankle injuries


Plint, AC, Bulloch, B, Osmond, MH, Stiell, I, Dunlap, H, Reed, M, Tenenbein, ...

Objectives: To determine the sensitivity and specificity of the Ottawa Ankle Rules in children and to determine the potential change in x-ray utilization.