Tenderness to palpation of ankle (possibly over growth plate)
Soft tissue swelling
Distinguish from lateral ligamentous sprain by presence of point tenderness over physis
Soft tissue swelling
Ankle fracture 
Ankle sprain
Humerus fracture
Ankle dislocation
Femur fracture 
Ankle syndesmosis injury
Femur fracture
Radiograph-negative ankle injury 