Triplane fracture
Background
- Salter-Harris type IV fracture of distal tibia with components in all 3 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
- Admit for:
- Open fracture
- Signs of neurovascular injury
- Concern for compartment syndrome