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https://upload.orthobullets.com/topic/4029/images/triplane ap_moved.jpg
https://upload.orthobullets.com/topic/4029/images/ossification pattern.jpg
https://upload.orthobullets.com/topic/4029/images/preopap.jpg
https://upload.orthobullets.com/topic/4029/images/preoplat.jpg
https://upload.orthobullets.com/topic/4029/images/ctscan.jpg
https://upload.orthobullets.com/topic/4029/images/postop.jpg
Introduction
  • A complex SH IV fracture pattern with components in all three planes
    • triplane fractures may be 2, 3, or 4 part fractures
      • epiphysis fractured in sagittal plane (same as tillaux fracture) and therefore is seen on the AP radiograph 
      • physis separated in axial plane 
      • metaphysis fractured in coronal plane and therefore is seen on the lateral radiograph
  • Epidemiology
    • Occur between ages 10-17 years, mean 13 years
      • juvenile ankle physis ossifies in specific order, which leads to transitional fractures such as triplane and tillaux fractures
      • distal tibia physis order of ossification
        • central > medial > lateral 
  • Mechanism
    • most are result of supination-external rotation similar to tillaux fractures (lateral triplane)
      • medial triplane is a result of adduction

Classification

  • Parts - 2, 3, 4 part
  • Lateral triplane (more common) > medial triplane >> intramalleolar triplane (epiphyseal fracture exits through medial malleolus)
Presentation
  • Symptoms
    • ankle pain, inability to bear weight
  • Physical exam
    • swelling, focal tenderness
Imaging
  • Radiographs
    • recommended views
      • AP
      • lateral
      • mortise
    • findings
      • consists of 3 parts
        • anterolateral quadrant of distal tibial epiphysis
        • medial and posterior portions of epiphysis with posterior metaphyseal spike
        • tibial metaphysis
      • AP radiograph shows Salter-Harris III  
      • lateral radiograph shows Salter-Harris II 
  • CT scan 
    • usually required to delineate fracture pattern and access articular congruity
    • fracture involvement seen in all 3 planes 
Treatment
  • Nonoperative
    • cast immobilization
      • indications
        • < 2 mm displacement
  • Operative
    • CRPP vs ORIF
      • indications
        • > 2 mm displacement
      • techniques
        • epiphyseal screw placed parallel to physis 
        • arthroscopic aided reduction can be used
Complications
  • Ankle pain and degeneration
    • articular step-off >2mm
 

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Questions (2)

(OBQ06.160) Figures A and B show an AP and lateral radiographs of a 15-year old boy who injured his ankle after skateboarding. What is the mechanism of injury with this type of fracture? Review Topic

QID: 346
FIGURES:
1

supination - adduction

9%

(209/2318)

2

external rotation

76%

(1758/2318)

3

internal rotation

3%

(58/2318)

4

pronation - abduction

8%

(180/2318)

5

axial load

4%

(96/2318)

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