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Supination Plantar Flexion Injuries:

- Discussion:
     - w/ foot in full supination, ankle is submitted to plantar flexion force;
     - most often causes a SH type II frx (less often SH I) of distal tibia;
     - fibular fracture may or may not be present;

- Radiograph:
     - on lateral x-ray look for posterior metaphyseal fragment displaced posteriorly;
     - on lateral radiographs, the SH II frx w/ the posteromedial metaphyseal fragment may resemble a supination-external rotation frx;
             - the distinction between the 2 frx is made on the AP view; 

- Non Operative Treatment:
    - long leg cast for 4-6 weeks;

- Closed Reduction:
    - best performed under GEA; 
    - ankle must be distracted inorder to disengage the fracture surfaces;
    - in some cases, external fixation (spanning the ankle) is utilized to not only assist with temporary distraction, but also to maintain the reduction;
    - foot must be dorsiflexed to counteract the deforming force of the Achlles tendon; 
    - in some cases with a signficant tight heel cord, the knee will have to be flexed (too relax the gastroc) so that the reduction can procede;
    - in this frx pattern, periosteum may become entraped into anterior aspect of frx;
           - requires, removal of periosteum via anteromedial incision, followed by closed reduction; 

consider fixation with a single anterior to posterior cannulated screw;
    - fixation of the fibula if there is displacement, especially on the lateral view

Plantar flexion injuries of the ankle. An experimental study.

Compartment syndrome with an isolated Salter Harris II fracture of the distal tibia.

Irreducible Salter-Harris type II fracture of the distal tibial epiphysis.

Compartment syndrome of the calf and foot following a displaced Salter-Harris type II fracture of the distal tibia: a review of the literature and a case report.