A run over injury of the ankle in a traffic accident is considered high-energy trauma, which can cause severe damage of the musculoskeletal system. This paper focuses on the cases of children with open growth plates, and severe ankle trauma.In all 6 cases, the skin and soft tissues, tendons, and bones were involved. The skin and soft tissue injuries included massive skin defects or severe scar contractures, all of which were successfully covered with a free groin flap, harvested from the contralateral side. Tendon injuries, mostly defects, included isolated or combined ruptures of the tibialis anterior, extensor hallucis longus, or extensor digitorum longus, which were reconstructed with tendon transfers or grafts. A hammer toe deformity was apparent in one untreated case.Concerning bone injuries, there were 4 cases of epiphyseal fractures of the tibia and fibula, and 2 cases of epiphyseal injuries of supination-inversion type, one of which followed an open dislocation of the ankle joint. In these 2 cases, a residual varus deformity of the ankle occurred, and in one of them a leg lengthening procedure was recently performed due to 3cm shortening.Microsurgical flaps have resolved the difficulties with wound management, but epiphyseal injuries remain the serious problem in which additional procedures would be necessary.