In this issue of JAMA Pediatrics, Boutis and colleagues determine the true rate of Salter-Harris I growth plate fractures of the distal fibula (SH1DF) among children with ankle injuries. Ankle injuries are common in children, leading to more than 2 million emergency department (ED) visits in Canada and the United States each year. Most ankle injuries are minor—85% due to forced inversion—and clinical decision rules help guide the need for radiography. Clinicians worry about missing a potential growth plate fracture, which could result in growth arrest, although the likelihood of growth arrest is rare.
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