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Pediatric ankle injuries: utilizing the Dias-Tachdjian classification

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Abstract

Pediatric ankle injuries require timely diagnosis due to their involvement of the distal tibial physis and subsequent impact on long bone growth. These injuries occur in a predictable pattern based on ankle position, direction of force, and degree of closure of the distal tibial physis. The Dias-Tachdjian classification describes possible ankle injury patterns for the completely open physis, and we present a simplified algorithm for applying this system in routine radiographic interpretation. Similar to the Lauge-Hansen classification in adults, the Dias-Tachdjian system is based on the position of the foot and direction of force at the time of injury with four major patterns: supination-inversion, pronation-eversion external rotation, supination-plantar flexion, and supination-external rotation. In addition, we examine the effect that the closing distal tibial physis has on adolescent fracture patterns (specifically, Tillaux and triplane fractures). Awareness of these injury patterns helps the radiologist to identify nondisplaced fractures and subtle physeal injuries with implications for surgical and/or conservative management.

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Acknowledgments

We thank Xochitl Vinaja MS, CMI for her extensive help with the medical illustrations in this paper.

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Authors and Affiliations

  1. Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA

    Christy B. Pomeranz & Roger J. Bartolotta

  2. Department of Radiology, NewYork-Presbyterian Hospital, 525 E. 68th Street, New York, NY, 10065, USA

    Christy B. Pomeranz & Roger J. Bartolotta

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  1. Christy B. Pomeranz
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  2. Roger J. Bartolotta
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Correspondence to Christy B. Pomeranz.

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Pomeranz, C.B., Bartolotta, R.J. Pediatric ankle injuries: utilizing the Dias-Tachdjian classification. Skeletal Radiol 49, 521–530 (2020). https://doi.org/10.1007/s00256-019-03356-0

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