Ankle fractures in children and adolescents usually involve the distal tibial and fibular epiphysis. Unless ade - quately treated, these fractures may be associated with many complications including limb length discrepancy and angular deformities due to growth arrest, and arthri - tis due to joint involvement. Fractures of the distal tibial epiphysis are classified according to the type and mecha - nism of injury. Salter-Harris type 1 and 2 fractures of the ankle have a good prognosis and can be treated by closed reduction. However, type 3 and 4 fractures involving the medial malleolus require surgical treatment because they usually result in compression of the physeal plate and cause angular deformities. External rotation of the foot may result in juvenile Tillaux fractures and triplane frac - tures of the distal tibia in the transitional period during which asymmetric physiologic closure of the distal tibial physis occurs. These are combinations of Salter-Harris type 2, 3, and 4 fractures, consisting of two or three frag - ments. Although they are not associated with growth arrest, they may lead to arthritis due to joint involvement. The presence of residual displacement of more than two millimeters necessitates surgical treatment.