Aim of study Setting an investigation and therapeutical algorythm in paediatric patients with a distal tibiofibular joint injury.

Material: The authors present their clinical material collected during the period of last five years (from 1997 to 2001). 222 children with physeal injury of the distal tibia and/or fibula were treated in the Regional Paediatric Trauma Centre in Prague Krè.

Methods: In all patients with an injury of the ankle joint, a plain X-ray scanning in two basic planes was performed. In any doubts oblique views or an X-ray scan of the ankle joint in a stress position were added. In some patients it was necessary to complete the investigation by CT scans.

Results: Only 9 % of all 222 selected patients sustained the distal tibiofibular joint injury. In 85 % of them the skeletal injury was evident (the juvenile Tillaux fracture of Salter’s type 3 or 4). In the rest 15 % (three cases) there was no skeletal trauma visible on neither plain nor oblique X-ray scans but CT scan showed it.

Conclusions: Injury to the distal tibiofibular joint is very rare in the growing skeleton. Most of our patients were of premature age. There is a danger of missing this rare but subsequently serious injury. That’s why we recommend the use of CT in all cases of ankle joint injury in children. Children with fractures (juvenile Tillaux fracture) displaced more than 2 mm should be operated on (closed reduction and internal fixation). In two girls we had to stabilise the distal tibiofibular joint due to severe ligamentous injury.