Triplane fracture

Background

• Salter-Harris type IV fracture of distal tibia with components in all 3 planes
  • Planes
    • Epiphysis fractured through sagittal plane
    • Physis fractured transversely (lateral open end to medial fused end)
    • Metaphysis fractured in coronal plane
• Occurs typically in adolescents, between ages 10-17
  • Physiological closure of the growth plate begins medially
  • Lateral growth plate is open and vulnerable to this type of fracture
• Typically a result of external rotation force

Clinical Features

• Ankle pain/deformity
• Inability to bear weight
• Local tenderness

Differential Diagnosis

Distal Leg Fracture Types

• Tibial plateau fracture
• Tibial shaft fracture
• Pilon fracture
• Maisonneuve fracture
• Tibia fracture (peds)
• Ankle fracture
  • Ankle fracture (peds)
    • Tillaux fracture
• Foot and toe fractures

Evaluation

• Assess distal pulse, motor, and sensation
• XR
  • AP view shows Salter-Harris III fracture
  • Lateral view shows Salter-Harris II fracture
• CT
  • Often required to delineate degree of injury
  • Fracture involvement seen in all three planes

Management

• Ortho consult in ED
• Nonoperative
  • Usually sufficient, indicated in <2 mm displacement
• Operative
  • If >2 mm displacement

Disposition

• Most can be followed as outpatient
• Admit for:
  • Open fracture
  • Signs of neurovascular injury
  • Concern for compartment syndrome

Complications

• Growth arrest (about 1/3 of injuries)
• Compartment syndrome

See Also

• Salter-Harris fractures
• Tillaux fracture