Triplane fracture: Difference between revisions
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==Background== | ==Background== | ||
*Salter-Harris type IV fracture of distal tibia with components in all 3 planes | *[[Salter-Harris]] type IV fracture of distal tibia with components in all 3 planes | ||
**Planes | **Planes | ||
***Epiphysis fractured through sagittal plane | ***Epiphysis fractured through sagittal plane | ||
***Physis fractured | ***Physis fractured transversely (lateral open end to medial fused end) | ||
***Metaphysis fractured in coronal plane | ***Metaphysis fractured in coronal plane | ||
*Occurs typically in adolescents, between ages 10-17 | *Occurs typically in adolescents, between ages 10-17 | ||
| Line 34: | Line 34: | ||
==Disposition== | ==Disposition== | ||
*Most can be followed as outpatient | *Most can be followed as outpatient<ref>Schnetzler KA, Hoernschemeyer D. The pediatric triplane ankle fracture. J Am Acad Orthop Surg 2007; 15(12): 738-47.</ref> | ||
* | ===Admit for=== | ||
*[[Open fracture]] | |||
*Signs of neurovascular injury | |||
*Concern for [[compartment syndrome]] | |||
==Complications== | |||
*Growth arrest (about 1/3 of injuries) | |||
*[[Compartment syndrome]] | |||
==See Also== | ==See Also== | ||
| Line 45: | Line 50: | ||
==External Links== | ==External Links== | ||
*https://www.orthobullets.com/pediatrics/4029/triplane-fractures | |||
*https://radiopaedia.org/articles/triplane-fracture | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | |||
[[Category:Pediatrics]] | |||
Latest revision as of 17:56, 19 March 2018
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
- Planes
- 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
- 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[1]
Admit for
- Open fracture
- Signs of neurovascular injury
- Concern for compartment syndrome
Complications
- Growth arrest (about 1/3 of injuries)
- Compartment syndrome
See Also
External Links
- https://www.orthobullets.com/pediatrics/4029/triplane-fractures
- https://radiopaedia.org/articles/triplane-fracture
References
- ↑ Schnetzler KA, Hoernschemeyer D. The pediatric triplane ankle fracture. J Am Acad Orthop Surg 2007; 15(12): 738-47.