title: Traumatic avulsion of the superior extensor retinaculum of the ankle as a cause of subperiosteal haematoma of the distal fibula in children. A retrospective study of 7 cases.
abstract: OBJECTIVE
  To describe a new sonographic feature for a traumatic lesion of the ankle in children.
  
  
  METHODS
  We present a retrospective review of superior extensor retinaculum (SER) avulsions diagnosed by ultrasound (US) as a cause of subperiosteal haematoma (SPH) and periosteal apposition of the distal fibula in seven children (3 girls and 4 boys, mean age 13.4 years; age range 10-15 years) after an inversion trauma of the ankle. Two children were subsequently examined with magnetic resonance imaging (MRI).
  
  
  RESULTS
  At the acute phases (6 children), US showed a hypoechoic collection with periosteal elevation at the fibular insertion of the SER. The fibular cortex and growth plate were unremarkable. The SPH was isolated in three cases and associated with an anterior talofibular ligament sprain in four. In two cases, MRI confirmed the SER periosteal avulsion and the integrity of the distal fibula. At the later phase (one child), US showed a periosteal apposition at the fibular insertion of the SER with hypoechoic thickening of the SER and power Doppler hyperaemia.
  
  
  CONCLUSIONS
  This is the first sonographic description of SER avulsion as cause of SPH of the distal fibula in children. SPH in children should not be considered as pathognomonic of a Salter-Harris type 1 lesion of the distal fibula. Later, it may be responsible for persistent ankle pain. Therefore, SER may be systematically explored in children during US examination of the ankle after trauma.
authors.affiliation: CHU Lille, Service de Radiopédiatrie, Hôpital Jeanne de Flandre, 59000, Lille, France. ding.juliette@gmail.com.|Univ. Lille, 59000, Lille, France. ding.juliette@gmail.com.
authors.forename: Juliette
authors.initials: J
authors.lastname: Ding
authors.affiliation: CHU Lille, Service de Radiopédiatrie, Hôpital Jeanne de Flandre, 59000, Lille, France.|Univ. Lille, 59000, Lille, France.|Imagerie Médicale Jacquemars Giélée, 73 rue Jacquemars Giélée, 59000, Lille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Moraux
authors.affiliation: CHU Lille, Clinique de Chirurgie Orthopédique Infantile, Hôpital Jeanne de Flandre, 59000, Lille, France.
authors.forename: Éric
authors.initials: É
authors.lastname: Nectoux
authors.affiliation: Univ. Lille, 59000, Lille, France.|CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d'Imagerie de l'Appareil Locomoteur, 59000, Lille, France.|Laboratoire d'Anatomie, Faculté de Médecine de Lille, 59045, Lille, Cedex, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Demondion
authors.affiliation: CHU Lille, Service de Radiopédiatrie, Hôpital Jeanne de Flandre, 59000, Lille, France.|Univ. Lille, 59000, Lille, France.
authors.forename: Élisa
authors.initials: É
authors.lastname: Amzallag-Bellenger
authors.affiliation: CHU Lille, Service de Radiopédiatrie, Hôpital Jeanne de Flandre, 59000, Lille, France.|Univ. Lille, 59000, Lille, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boutry
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D001847:Bone Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D002648:Child; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D017844:Lateral Ligament, Ankle / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D010521:Periosteum / Q000293:injuries*; D012189:Retrospective Studies
keywords: Ankle; Ankle injuries; Ultrasonography