Fracturas del extremo distal del radio en el esqueleto inmaduro: estudio epidemiológico en el Centro Hospitalario Pereira Rossell / Fraturas da extremidade distal do rádio no esqueleto imaturo: estudo epidemiológico no Hospital Pereira Rossell / Fracture of the distal end of the radius in children: epidemiological study at the Pereira Rossell Hospital Center

Objetivo principal: Conocer la epidemiologia de las fracturas del cuarto distal del radio en el esqueleto en crecimiento y el tratamiento realizado en el CHPR en los años 2017 y 2018. Objetivos específicos: Valorar re-desplazamiento, necesidad de re manipulación, complicaciones, re-fractura. Metodología: Estudio observacional descriptivo retrospectivo. Criterios de inclusión: pacientes de 0 a 14 años con fractura de radio distal (fisaria, metafisaria y suprametafisaria) valorados en el CHPR entre 1 enero del 2017 y 31 diciembre del 2018. Criterios de exclusión: pacientes con radiografía normal, fracturas en miembros con malformaciones, infecciones óseas, patología tumoral maligna o benigna. Obtención de datos: Valoración de radiografías de puño y antebrazo realizadas en el CHPR en 2017 y 18, iniciales y evolutivas. Se analizaron: edad, sexo, fecha fractura, topografía de la fractura, desplazamiento inicial, tratamiento, evolución radiográfica y complicaciones. Resultados: se incluyeron 662 pacientes. Siendo en su mayoría de género masculino (65%), con una media de 9 años, miembro derecho (61%), en los meses de verano (36%). En cuanto a la topografía se evidenció una frecuencia mayor en fracturas tipo rodete y metafisarias (31.72% y 31.57%), seguido por suprametafisaria (18.43%) y fisaria (18.28%). El tratamiento realizado fue ortopédico en el 86.56% de los casos, mientras que quirúrgico fue el 12.84%, en su gran mayoría con alambres de Kirschner (11,2%). El tiempo de inmovilización promedio fue de 6 semanas, con un porcentaje de complicaciones del 14.05% del total de las fracturas. Conclusiones: Se valoraron las características de los pacientes y fracturas de radio distal en el CHPR en los años 2017 y 18, siendo un total de 662 fracturas, en las que su mayoría se realizó tratamiento ortopédico con un índice de complicaciones que ronda el 14%, siendo mayor cuanto mayor es el desplazamiento inicial de la fractura.

Objetivo principal: Conhecer a epidemiologia das fraturas do quarto distal do rádio no esqueleto em crescimento e o tratamento realizado no CHPR nos anos de 2017 e 2018. Objetivos específicos: Avaliar re-deslocamento, necessidade de remanipulação, complicações, refratura. Metodologia: Estudo observacional descritivo retrospectivo. Critérios de inclusão: pacientes de 0 a 14 anos com fratura do rádio distal (fisário, metafisário e suprametafisário) avaliados no CHPR entre 1º de janeiro de 2017 e 31 de dezembro de 2018. Critérios de exclusão: pacientes com radiografias normais, fraturas em membros com malformações, osso infecções, patologia tumoral maligna ou benigna. Coleta de dados: Avaliação das radiografias de punho e antebraço realizadas no CHPR em 2017 e 18, inicial e evolutiva. Foram analisados: idade, sexo, data da fratura, topografia da fratura, deslocamento inicial, tratamento, evolução radiográfica e complicações. Resultados: 662 pacientes foram incluídos. Sendo maioritariamente do sexo masculino (65%), com média de 9 anos, membro direito (61%), nos meses de verão (36%). Em relação à topografia, foi evidenciada maior frequência nas fraturas da borda e metafisárias (31,72% e 31,57%), seguidas das suprametafisárias (18.43%) e fisárias (18.28%). O tratamento realizado foi ortopédico em 86.56% dos casos, enquanto cirúrgico em 12.84%, sendo a maioria com fios de Kirschner (11,2%). O tempo médio de imobilização foi de 6 semanas, com percentual de complicações de 14.05%. Conclusões: Foram avaliadas as características dos pacientes e fraturas do rádio distal no CHPR nos anos de 2017 e 18, com um total de 662 fraturas (0,9 por dia), em que a maioria foi submetida a tratamento ortopédico com índice de complicações que fica em torno de 14%, sendo maior quanto maior for o deslocamento inicial da fratura.

Title: Fractures of the distal end of the radius in the immature skeleton. Epidemiological study at the Pereira Rossell Hospital Center. Main objective: To know the epidemiology of fractures of the distal fourth of the radius in the growing skeleton and the treatment carried out in the CHPR in the years 2017 and 2018. Specific objectives: To assess re-displacement, need for re-manipulation, complications, re- fracture. Methodology: Retrospective descriptive observational study. Inclusion criteria: patients aged 0 to 14 years with distal radius fracture (physeal, metaphyseal and suprametaphyseal) evaluated at the CHPR between January 1, 2017 and December 31, 2018. Exclusion criteria: patients with normal radiographs, fractures in limbs with malformations, bone infections, malignant or benign tumor pathology. Data collection: Assessment of fist and forearm X-rays performed at the CHPR in 2017 and 18, initial and evolutionary. The following were analyzed: age, sex, fracture date, fracture topography, initial displacement, treatment, radiographic evolution and complications. Results: 662 patients were included. Being mostly male (65%), with an average of 9 years, right limb (61%), in the summer months (36%). Regarding the topography, a higher frequency was evidenced in rim and metaphyseal fractures (31.72% and 31.57%), followed by suprametaphyseal (18.43%) and physeal (18.28%). The treatment performed was orthopedic in 86.56% of the cases, while surgical was 12.84%, mostly with Kirschner wires (11.2%). The average immobilization time was 6 weeks, with a percentage of complications of 14.05%. Conclusions: The characteristics of the patients and fractures of the distal radius in the CHPR in the years 2017 and 18 were evaluated, with a total of 662 fractures (0.9 per day), in which the majority underwent orthopedic treatment with an index of complications that is around 14%, being greater the greater the initial displacement of the fracture.

Fracturas metafisarias de radio distal desplazadas en el esqueleto en crecimiento: ¿cuál es el mejor método terapéutico? revisión bibliográfica sistematizada / Displaced distal radius metaphyseal fractures in the growing skeleton: what is the best therapeutic method? systematized bibliographic review / Fraturas metafisárias do rádio distal deslocadas no esqueleto em crescimento: qual é o melhor método terapêutico? revisão bibliográfica sistematizada

Introducción: Las fracturas metafisarias de radio distal son las fracturas más frecuentes en la edad pediátrica, siendo 30% del total de las mismas. Mantener la reducción de las fracturas desplazadas no siempre es posible: el re-desplazamiento es la principal complicación de estas lesiones. Clásicamente se realizó tratamiento con maniobra y yeso, aunque en los últimos años se asoció fijación con Kirschner wire (Kw) en búsqueda de disminuir el re-desplazamiento. El objetivo de nuestro trabajo es identificar factores de riesgo en búsqueda de realizar el mejor tratamiento siendo lo menos agresivo posible. Materiales y métodos: Se realizó una búsqueda sistematizada a través del buscador electrónico PubMed. La misma alcanzó un total de 4594 artículos, que de acuerdo con los criterios de inclusión y exclusión se seleccionaron 15 trabajos para realizar nuestra revisión bibliográfica. Resultados: Se destaca que la mayoría de los artículos encontrados son de nivel de evidencia III y IV. Nuestra búsqueda refleja un índice de re-desplazamiento entre 20-39% mediante yeso a las 2 semanas; asi como un índice de re-manipulación entre el 5-10 % del total de las fracturas desplazadas. La mayoría de los estudios analizados intentan identificar los factores de riesgo más importantes para el re-desplazamiento de las fracturas, de lo que se destacan el grado de desplazamiento inicial de la fractura y la reducción lograda de la misma. A su vez, otros artículos valoran los resultados del tratamiento mediante estabilización con yeso o fijación mediante Kirschner wire. Conclusión: el desplazamiento inicial de la fractura y la reducción lograda en block quirúrgico (BQ) son los factores de riesgo más importantes para el re-desplazamiento. Si bien la técnica de enyesado no es considerado una variable estadísticamente significativa, es considerada una variable importante en cuanto al pronóstico de la lesión, destacando al moldeado de 3 puntos como principal índice a considerar. Se considera aconsejable asociar un Kw en aquellas fracturas cabalgadas en las que no se logra una reducción anatómica en block quirúrgico.

Introduction: Distal radius metaphyseal fractures are the most frequent fractures in pediatric age, accounting for 30% of the total. Maintaining the reduction of displaced fractures is not always possible: re-displacement is the main complication of these injuries. Classically, treatment was performed with a maneuver and a cast, although in recent years fixation with Kirschner wire (Kw) has been associated in search of reducing re-displacement. The objective of our work is to identify risk factors in search of the best treatment while being the least aggressive possible. Materials and methods: A systematic search was carried out using the PubMed electronic search engine. It reached a total of 4594 articles, which according to the inclusion and exclusion criteria, 15 papers were selected for our bibliographic review. Results: It should be noted that most of the articles found are level of evidence III and IV. Our search reflects a re-displacement rate between 20-39% using a cast at 2 weeks; as well as a re-manipulation index between 5-10% of all displaced fractures. Most of the studies analyzed attempt to identify the most important risk factors for the re-displacement of fractures, of which the degree of initial displacement of the fracture and the reduction achieved are highlighted. In turn, other articles assess the results of treatment by stabilization with plaster or fixation with Kirschner wire. Conclusion: the initial displacement of the fracture and the reduction achieved in the surgical block (BQ) are the most important risk factors for re-displacement. Although the casting technique is not considered a statistically significant variable, it is considered an important variable in terms of the prognosis of the injury, highlighting the 3-point casting as the main index to be considered. It is considered advisable to associate a Kw in those mounted fractures in which an anatomical reduction in surgical block is not achieved.

Introdução: As fraturas metafisárias do rádio distal são as mais frequentes na idade pediátrica, correspondendo a 30% do total. Manter a redução das fraturas desviadas nem sempre é possível: o deslocamento é a principal complicação dessas lesões. Classicamente, o tratamento era realizado com manobra e gesso, embora nos últimos anos a fixação com fio de Kirschner (Kw) tenha sido associada na busca pela redução do deslocamento. O objetivo do nosso trabalho é identificar os fatores de risco em busca do melhor tratamento sendo o menos agressivo possível. Materiais e métodos: uma busca sistemática foi realizada usando o mecanismo de busca eletrônico PubMed. Chegou-se a um total de 4.594 artigos, que de acordo com os critérios de inclusão e exclusão, foram selecionados 15 artigos para nossa revisão bibliográfica. Resultados: Ressalta-se que a maioria dos artigos encontrados são de nível de evidência III e IV. Nossa pesquisa reflete uma taxa de re-deslocamento entre 20-39% usando um gesso em 2 semanas; bem como um índice de remanipulação entre 5-10% de todas as fraturas deslocadas. A maioria dos estudos analisados ​​busca identificar os fatores de risco mais importantes para o deslocamento das fraturas, que incluem o grau de deslocamento inicial da fratura e a redução alcançada. Por sua vez, outros artigos avaliam os resultados do tratamento com estabilização gessada ou fixação com fio de Kirschner. Conclusão: o deslocamento inicial da fratura e a redução alcançada no bloqueio cirúrgico (QB) são os fatores de risco mais importantes para o deslocamento. Embora a técnica de gesso não seja considerada uma variável estatisticamente significativa, é considerada uma variável importante em termos de prognóstico da lesão, destacando-se o gesso em 3 pontos como o principal índice a ser considerado. Considera-se aconselhável associar um Kw nas fraturas montadas em que não se consegue redução anatômica no bloqueio cirúrgico.

Morphology of endoskeleton and spination in the sea star Midgardia xandaros (Brisingida: Brisingidae) from the Gulf of Mexico / Morfología del endoesqueleto y ornamentación de la estrella de mar Midgardia xandaros (Brisingida: Brisingidae) en el Golfo de México

Introduction: The deep-sea asteroid species of Brisingida have a nearly global distribution but have remained poorly understood due to their deep bathymetric distributions and fragile skeletons. Objective: To describe the external and internal morphology of Midgardia xandaros including the skeletal arrangement, through multifocal and SEM techniques. Methods: We examined a total of 21 specimens, including 27 arm fragments, from the Gulf of Mexico and Honduras. Two specimens were dissected. Results: Detailed descriptions of pedicellariae, abactinal, intercostal, inferomarginal, adambulacral, ambulacral, odontophore, and oral ossicles, and their spines are provided, emphasizing the articulations and muscle attachments. C-shaped valves pedicellariae and small pedicellariae valves with shorter denticulation areas were recognized. Conclusions: The morphological description of M. xandaros is expanded, providing the most extensive description of abactinal, first adambulacral, first and subsequent inferomarginal ossicles, abactinal spines, and C-shaped, crossed pedicellariae, as well as the distal arm plates, for a brisingid species using SEM to date.

Introducción: Las estrellas de mar de profundidad del orden Brisingida tienen una distribución casi global, sin embargo, han sido poco estudiadas debido a su profunda distribución batimétrica y esqueleto frágil. Objetivo: Describir la morfología externa e interna de Midgardia xandaros incluyendo el arreglo de las placas del esqueleto mediante técnicas de microscopía multifocal y electrónica de barrido (MEB). Métodos: Se examinó un total de 21 ejemplares, incluyendo 27 fragmentos de brazos, provenientes del Golfo de México y Honduras. Dos de estos ejemplares fueron disectados. Resultados: Se presenta la descripción de pedicelarios; placas abactinales, intercostales, inferomarginales, adambulacrales, ambulacrales, orales y odontóforo, y sus espinas, enfatizando los sitios de articulaciones e inserción de músculos. Se reconocieron pedicelarios con valvas con forma de C, y pequeños pedicelarios cuyas valvas poseen áreas de denticulación cortas. Conclusiones: La descripción morfológica de M. xandaros es ampliada, presentado por primera vez la morfología de las placas abactinales, primera adambulacrales, primera y subsecuentes inferomarginales, espinas abactinales y pedicelarios con valvas con forma de "C", así como las placas distales de los brazos para una especie del orden Brisingida.

Esqueletogênese em punaré (Thrichomys laurentinus- Rodentia, Echimyidae) / Skeletogenesis in punare (Thrichomys laurentinus - Rodentia, Echimyidae)

O objetivo deste estudo foi descrever o desenvolvimento do esqueleto do punaré (Thrichomys laurentinus). Para tanto, foram utilizados 11 embriões e 12 fetos em diferentes estágios de desenvolvimento, sendo divididos em 4 grupos de acordo com o período gestacional. As amostras foram obtidas no Centro de Multiplicação de Animais Silvestres da Universidade Federal Rural do Semi-Árido, Mossoró-RN, Brasil. Após fixados em formol (10%) ou glutaraldeído (2,5%), foi realizada a analise morfológica com auxílio de lupa, sendo as características macroscópicas fotodocumentadas. Análises de raios-x e coloração por alizarina red foram realizadas para melhor compreensão do desenvolvimento ósseo. Nas análises de raio-x os embriões não apresentaram nenhuma radiopacidade, ao contrário dos fetos que apresentavam radiopacidade gradual ao longo dos grupos. No grupo II houve aumento de radiopacidade na região da coluna vertebral e das regiões mandibular e maxilar. No grupo III a radiopacidade estava aumentada nos membros pélvicos, nas costelas e na região frontal e no grupo IV nos membros torácicos e nas regiões occipital, temporal e frontal do crânio. Tais características foram confirmadas pelas analises histológicas e pela técnica de Alizarina Red. Com isso podemos concluir que o conhecimento acerca da embriologia do sistema ósseo normal é fundamental para o entendimento dos efeitos adversos causados pela nutrição e uso de drogas durante o desenvolvimento.(AU)

The aim of this study was to describe the skeletogenesis in punaré (Thrichomys laurentinus). We used 11 embryos and 12 fetuses in different stages of development, allocated into 4 groups. Samples were obtained from the Multiplication Center of Wild Animals, at Federal Rural University of the Semi-Arid, Mossoro/RN, Brazil. After fixed in formalin (10%) or glutaraldehyde (2.5%) the morphological analysis was performed with a magnifying glass, and the macroscopic characteristics were photographed. Analysis of X-rays and alizarin red staining was made to better understand the development of bone structures. In x-ray analysis, it was possible to verify that the embryos showed no radiopacity, unlike fetuses that had gradual radiopacity along of the groups. In group II, there was an increase in radiopacity in the spine, mandibular and maxillary regions. In group III, the radiopacity was increased in the hind limbs, ribs and in the frontal region, and group IV showed higher radiopacity in the thoracic limbs and occipital, temporal and frontal skull. These characteristics were confirmed by histological and alizarin red analysis. We concluded that the knowledge of normal skeletal embryology is critical for understanding of adverse effects caused by nutrition and use of drugs during the development.(AU)

Development of the vertebral column and caudal skeleton in Prochilodus lineatus larvae under laboratory conditions / Desarrollo de la columna vertebral y del esqueleto caudal en larvas de Prochilodus lineatus en condiciones de larvicultura intensiva

For successful fish larviculture thorough studies describing the development of fish in different morphological aspects are required, as they are crucial for larval survival and growth. The present study described in Prochilodus lineatus larvae the osteological development of the vertebral column and caudal skeleton 30 days after hatching (dah). Larvae were obtained by artificial induction of adults. The beginning of formation of the spine occurs between 10 to 12 dah (8.3 mm standard length, SL) simultaneously to the first neural and hemal processes and the pre-caudal vertebral bodies. The ossification of the vertebral column occurred in cranio-caudal direction and was completed at 28 dah (22.6 mm SL). The development of the caudal skeleton elements started between 6 and 8 dah with the formation of the hypurals (H), the parahipural (PH) and the primary and secondary caudal rays. H 1 to H 3 were formed as cartilaginous primordia on the ventral side of the distal portion of the notochord, while the PH and H 4 to H 6 were formed subsequently. The first rays of the caudal fin were observed in correspondence with the formation of H 2 and H 3, while complete formation of the caudal fin was observed at 28 dah. The epurals, three in number, were evident as cartilaginous elements located both dorsal and distal in the notochord. Central ural complex (CUC) was formed by the fusion of three structures, the center preural 1 and urals 1 and 2. Development of the vertebral column and the caudal skeleton in P. lineatus larvae showed similar patterns to those described for other teleosts.

Se describe el desarrollo osteológico de la columna vertebral y del esqueleto caudal en larvas de sábalo (Prochilodus lineatus) bajo condiciones controladas hasta los 30 días posteriores a la eclosión (dpe). El inicio de la formación de la columna vertebral fue observado entre los 10-12 dpe (8,3 mm de longitud estándar, LE) con la aparición de los primeros procesos neurales, hemales y cuerpos vertebrales pre-caudales. La osificación de la columna vertebral ocurrió en sentido cráneo-caudal y fue completa a los 28 dpe (22,6 mm LE). El esqueleto caudal inició su desarrollo entre los 6 y 8 dpe con la formación de los hipurales (H), parahipural (PH) y los radios caudales principales y secundarios. Los H 1 al 3 se formaron como primordios cartilaginosos en la cara ventral de la porción distal de la notocorda, mientras que posteriormente se formaron los H 4 al 6 y el PH. Los primeros radios de la aleta caudal fueron observados en correspondencia con la formación de los H 2 y 3, mientras que a los 28 dpe se observó la completa formación de los mismos, existiendo 10 radios en el lóbulo dorsal y 9 en el lóbulo ventral. Los epurales, en número de tres, fueron evidentes como elementos cartilaginosos en dorsal de la notocorda y distalmente a los arcos neurales, permaneciendo sin osificarse hasta los 25 dpe. El complejo centro ural se constituyó por la fusión de tres estructuras, el centro preural 1, el ural 1 y 2. El desarrollo de la columna vertebral y del esqueleto caudal muestran patrones similares a los descriptos en otros teleósteos.

Desarrollo Ontogénico de la Columna Vertebral y del Esqueleto Caudal en Larvas de Rhamdia quelen en Condiciones de Larvicultura Intensiva / Ontogenic Development of the Vertebral Column and Caudal Skeleton in Rhamdia quelen Larvae in Larviculture Intensive System

Se analiza por primera vez el desarrollo osteológico de la columna vertebral y del esqueleto caudal en larvas de Rhamdia quelen mantenidas bajo condiciones controladas y con alimentación artificial. Entre los días 1 a 20 posteriores a la eclosión (dpe) se muestrearon a intervalos regulares 400 larvas, que se colorearon y transparentaron siguiendo la técnica de Taylor & Van Dike. En los primeros días de vida, las larvas presentan una notocorda recta en toda su longitud. El inicio de la formación de la columna vertebral fue observado a los 7 dpe con la aparición de las espinas neurales y hemales, y entre los 9 y 10 dpe para las tres primeras vértebras. La osificación de la columna vertebral ocurrió en sentido cráneo-caudal y fue completa a los 20 dpe. El esqueleto caudal inicia su desarrollo entre los 3 y 4 dpe, con la formación de los hipurales (H), parahipural (PH) y los radios caudales. Los H 1 al 4 se formaron como primordios cartilaginosos en la cara ventral de la porción distal de la notocorda, mientras que posteriormente lo hicieron el H 5 y el PH en el extremo distal y proximal del esqueleto caudal, respectivamente. El complejo centro ural (CCU) se osificó inicialmente en dos partes, una anterior que resulta de la combinación del centro preural 1 y el ural 1 y una posterior con el ural 2. Los primeros radios de la aleta caudal aparecieron en larvas en flexión, mientras que después de los 13 dpe, todos los ejemplares presentaron los radios principales osificados (ocho en la parte superior y ocho en la inferior). El desarrollo de la columna vertebral y del esqueleto caudal en R. quelen muestra patrones similares a los descriptos en otros peces teleósteos aunque con algunas particularidades que lo diferencian de los grupos relacionados.

The osteological development of vertebral column and caudal skeleton in Rhamdia quelen larvae under controlled conditions and artificial feeding is analyzed. Between 1 to 20 day post hatching (dph) four hundred larvae were sampled at regular intervals, and subsequently colored and transparent following the Taylor & Van Dyke technique. In the first days of life, larvae have a straight notochord throughout its length. The beginning of the vertebral column formation was observed at 7 dph with the emergence of neural and haemal spines arches, and between 9 and 10 dph for the first three vertebrae. The ossification of the vertebral column occurred in cranial-caudal direction and was complete at 20 dph. The caudal skeleton begins to develop between 3 and 4 dph, with the formation of the hypurals (H), parahipural (PH) and caudal fin rays. The H 1 to 4 were formed as cartilaginous primordia on the ventral surface of the distal portion of the notochord, and then later the H 5 and PH in distal and proximal extreme of the caudal skeleton, respectively. Central ural complex (CUC) was ossified in two parts, one anterior that is a combination of central preural 1 and ural 1 and other posterior with the ural 2. The first caudal fin rays appear in flexion larvae, while after 13 dph, all specimens had ossified principal rays (eight rays in both upper and lower lobes). The development of the vertebral column and caudal skeleton shows similar patterns to those described in other teleost fish although with some peculiarities that differentiate it from related groups.

Digital radiograph of the middle phalanx of the third finger (MP3) region as a tool for skeletal maturity assessment.

Objective: To evaluate the reliability of the digital radiograph of the middle phalanx of the third finger (MP3) in skeletal maturity assessment Study Design: Fifty children (24 girls and 26 boys) belonging to the circumpubertal age-group were selected for the study. Two radiographs - lateral cephalogram and digital radiograph of the MP3 region - were taken in each child. Age assessment was based on the changes in shape of the cervical vertebrae and the epiphysis of the middle phalanx of the third finger of the left hand. The radiographs were assessed by three examiners. The inter- and intraexaminer variability were determined by the Wilcoxon rank sign test and the Kruskal-Wallis test and were found to be nonsignificant. Examiner 3 showed the best intraexaminer agreement and was selected to evaluate the radiographs for the entire study. Results: The correlation determined between the MP3 stages and cervical vertebrae maturity index (CVMI) stages, the peak-wise distribution of the MP3 stages, and the correlation between the MP3 stages and the chronological age were found to be highly significant. Conclusions: Digital radiograph of the MP3 region is definitely a simple, reliable, cost-effective, and time-saving technique for the assessment of skeletal maturity.

Ankle injuries in the growing skeleton. a review of the recent literature

Ankle injuries arise with significant frequency in the pediatric population, although diagnosis is rarely straightforward. Contact sports, such as football are widely practiced in Saudi athletes, little is carried out to educate them of measures regarding playing conditions and prophylactic steps like foot wear, warming up, and similarly. The usual potential complications associated with trauma to mature skeleton, as well as immature selection includes post-traumatic arthritis, stiffness, reflex sympathetic dystrophy, as well as those seen with physeal damage including leg length discrepancy, angular deformities, or a combination. Knowledge of these injuries, as well as the differences between children and adult skeleton is essential for proper and effective management of these common injuries. This article is a review of anatomy, physiology of physis, diagnostic modalities, prognosis, treatment methods and analyzing, and highlighting data from the published literature regarding ankle injuries in growing skeleton, which is crucial to manage these injuries