Imaging description

Triplane fracture occurs in the distal tibia before complete closure of the physis. As the name implies there are three fracture planes. Coronal oblique fracture is seen in the posterior metaphysis on the lateral radiograph (Figure 64.1). Sagittal epiphyseal fracture is seen on the AP or mortise view (Figure 64.2). Axial physeal fracture commonly involves the lateral aspect of the physis, which may be widened. Triplane fractures are further classified based on the number of the fracture fragments (two, three, or four fragments) and the location of epiphyseal fractures. CT (Figure 64.3) is commonly indicated to evaluate the surgical indication and pre-operative planning.

Importance

Triplane fracture does not fit into the Salter–Harris classification of physeal fractures because of its complexity. Prompt diagnosis and accurate assessment of the fracture extension and displacement are important as they change the management and likely the prognosis. Non-displaced fractures and extra-articular fractures can be managed conservatively. Displaced fractures are surgically treated. Intra-articular reduction to within 2 mm is required for optimal treatment of triplane fractures. The presence of a fibular fracture appears to be associated with an increased incidence of unsuccessful closed reductions. Complications include premature physeal closure, angular deformities, and joint incongruity with subsequent degenerative arthritis.