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In this issue of JAMA Pediatrics, Boutis and colleagues1 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.1,2 Most ankle injuries are minor—85% due to forced inversion—and clinical decision rules help guide the need for radiography.3 Clinicians worry about missing a potential growth plate fracture, which could result in growth arrest, although the likelihood of growth arrest is rare.4
Gill PJ, Klassen T. Revisiting Radiograph-Negative Ankle Injuries in ChildrenIs It a Fracture or a Sprain?. JAMA Pediatr. 2016;170(1):e154147. doi:10.1001/jamapediatrics.2015.4147