Comminuted epiphyseal fracture of the distal tibia. A case report and review of the literature

The pediatric triplane ankle fracture

The pediatric triplane ankle fracture represents a unique spectrum of injury that does not fit neatly into the Salter-Harris classification of physeal injury. This fracture is particular to the pediatric population and often is termed a transitional injury. It is the result of the characteristic asymmetric closure of the distal tibial physis over a period of approximately 18 months. The triplane ankle fracture is a multiplanar injury with three classically described fracture fragments. It has several variations and represents 5% to 10% of pediatric intra-articular ankle injuries. The fracture typically presents in children aged 12 to 15 years; incidence is slightly higher in boys than in girls. Nondisplaced triplane fractures and extra-articular fractures can be managed with immobilization in a long leg cast. Displaced fractures are treated with open reduction and internal fixation performed through an anterolateral approach or an anteromedial approach. Intra-articular reduction to within 2 mm is required for optimal treatment of these unique pediatric ankle fractures.

Sports injuries in the pediatric and adolescent foot and ankle: common overuse and acute presentations

Care of the youth athlete requires knowledge of developmental anatomy and specific injury patterns, which are acute or chronic in nature. We may expect that the incidence of overuse and acute foot and ankle injuries in this population is likely to increase in proportion to the number and intensity of competitive youth teams with demanding training schedules. We, as physicians, must exercise our best judgment in regard to recognizing these patterns early and instituting appropriate treatments. Return to play decisions should be based on objective criteria when available and always keeping the best interest of the athlete's future health in the forefront of our minds.

The complex triplane fracture: ipsilateral tibial shaft and distal triplane fracture

BACKGROUND

The complex triplane fracture (ipsilateral tibial shaft and distal tibial triplane fracture) is a rare combination. It has not previously been described in the literature. This combination can be easily overlooked and has the potential for serious sequelae if it is missed.

METHODS

Six patients, having sustained this combined injury, were reviewed at a tertiary children's hospital. Clinical assessment, radiographs, computed tomographic scans, bone age, and scanogram assessment of leg length at maturity were completed.

RESULTS

Average age at injury was 14 years. Tibial fractures were midshaft or short oblique. There were 3 three-part and 3 two-part intra-articular distal tibial triplane fractures. Diagnosis of the distal triplane fracture was delayed in two cases. Treatment involved application of a long leg cast. No patients required open reduction. At follow-up (average, 22 months), all patients were asymptomatic. All fractures were well healed and there was no evidence of joint incongruity, or angular or rotational deformity. Leg length discrepancy averaged 6.8 mm.

CONCLUSION

A high index of suspicion should be maintained to avoid missing this rare combination, as it has the potential for long-term sequelae.

Distal tibial triplane fractures: long-term follow-up

The cases of 35 patients in whom a triplane fracture had been treated at the Ramón y Cajal Hospital were reviewed. The diagnosis of biplane and triplane fracture can now be made by standard radiograph. However, plain radiographs alone did not accurately demonstrate the configuration of the fracture, and computed tomography must be performed. Closed reduction should be attempted first. Failure to obtain or maintain (or both) an adequate closed reduction is an indication for operative treatment. Prognosis is surprisingly good. Only when adequate reduction (< 2 mm displacement) has not been achieved can degenerative changes be seen at long-term follow-up (> 5 years).

Triplane fractures of the adolescent ankle--a report of three cases

Three cases of triplane fractures of the distal end of the tibia are presented. There are usually two or three fragments and it occurs in adolescents in whom there is little growth potential left; hence there is little growth disturbance despite premature closure of the physis. The key to successful treatment is to assess the degree of articular deformity and to restore articular congruity.

The triplane fracture of the distal tibial epiphysis in children

Two cases of triplane fracture of the ankle in children are presented. Both patients were treated conservatively with good results. The typical age incidence and difficulties in establishing the diagnosis by X-ray examination are discussed. Closed reduction and plaster immobilization is recommended. Only if joint congruity cannot be restored is operative treatment required.