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 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[1]

Admit for

Complications

See Also

References
  1. Schnetzler KA, Hoernschemeyer D. The pediatric triplane ankle fracture. J Am Acad Orthop Surg 2007; 15(12): 738-47.
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