Age / Sex : 13 / M

Chief complaint: Left ankle pain

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(답안은 한 개만 보내주시기 바랍니다)

Courtesy: 송호택 (Ho Taek Song), 연세대학교 세브란스병원 (Yonsei University Severance Hospital)

Triplane Fracture

Discussion

Findings:

Salter-Harris type III fracture on AP view and type II on lateral view.

Differential Diagnosis:

Tillaux fracture: Fracture of anterolateral portion of epiphysis of distal tibia

Diagnosis:  

Triplane Fracture

Discussion:

Atypical type of Salter-Harris classification.

3 types: Two-part, three-part, and four-part fracture

Fracture exists in the frontal, lateral, and transverse planes.

Mechanism of injury is forced external rotation.

Most commonly occurs just before epiphyseal closure.

Epiphyseal arrest and angular deformity are uncommon.

Accompany fibular spiral fracture in 50%.

Treatment:

1.     Non Operative Treatment for extra-articular fractures

2.     Open reduction internal fixation for > 2~2.5 mm displacement

References:

1, Choudhry IK1, Wall EJ, Eismann EA, Crawford AH, Wilson L. Functional Outcome Analysis of Triplane and Tillaux Fractures After Closed Reduction and Percutaneous Fixation. J Pediatr Orthop. 2013 Oct 29.

2 Tan AC, Chong RW, Mahadev A. Triplane fractures of the distal tibia in children. J Orthop Surg (Hong Kong). 2013 Apr;21(1):55-9.