Triplane or triplanar fractures are of the distal tibia only occurring in adolescents. As the physiological closure of the physeal plate begins medially, the lateral (open) physis is prone to this type of fracture. The name is due to the fact of the fracture expanding both in frontal and lateral as well as transverse planes. Most authors regard it as a type IV Salter-Harris fracture.
It comprises of:
- a vertical fracture through the epiphysis
- a horizontal fracture through the physis
- an oblique fracture through the metaphysis
As physeal closure has to begin at an end, triplane fractures have occasionally been reported in other sites too, e.g. distal radius 2, proximal tibia 4, distal femur 5.
In adolescents with closing epiphyseal plate(s) they are the most common ankle joint fractures - along with Tillaux fractures.
Symptoms comprise of pain and inability to weight bear. Possible signs include swelling, localised/referred pain, and/or deformity of the ankle
External rotation is considered to be the main injury mechanism of the tibial type.
Due to the aforementioned characteristics the fracture typically appears in routine projections as follows:
- resembling Salter-Harris III fracture on AP views
- resembling Salter-Harris II fracture on lateral views
Small dislocations and the vertical fracture itself are not infrequently overlooked, why in cases of doubt it is advisable to perform
the imaging modality of choice, permitting identification of
- fracture shape i.e. fracture type itself
- number of fragments
- orientation and dislocation of fragment(s)
For the same reasons CT aids in treatment planning as well 6.
may be used to reveal associated ligament injuries and/or (osteo)chondral fractures 7.
Treatment and prognosis
Treatment options comprise surgery (i.e. open reduction and internal fixation - ORIF) and conservative management (i.e. long leg cast immobilization). Physeal arrest leading to angular deformity may occur but is considered rare.
History and etymology
The term was coined by L Marmor in 1970 8.
On radiographs, possible consdierations include
- 1. Kocher M, Millis MB. Operative Techniques: Pediatric Orthopaedic Surgery. Saunders. ISBN:1416049150. Read it at Google Books - Find it at Amazon
- 2. Mingo-Robinet J, Torres-Torres M, Gonzalez-Rodriguez M. Triplane fracture of distal radius treated surgically: case report and review of the literature. J Pediatr Orthop B. 2014;23 (3): 227-30. doi:10.1097/BPB.0000000000000011 - Pubmed citation
- 3. Randsborg PH, Gulbrandsen P, Saltytė Benth J et-al. Fractures in children: epidemiology and activity-specific fracture rates. J Bone Joint Surg Am. 2013;95 (7): e42. doi:10.2106/JBJS.L.00369 - Pubmed citation
- 4. Kanellopoulos AD, Yiannakopoulos CK, Badras LS. Triplane fracture of the proximal tibia. Am J. Orthop. 2004;32 (9): 452-4. Pubmed citation
- 5. Masquijo JJ, Allende V. Triplane fracture of the distal femur: a case report. J Pediatr Orthop. 2011;31 (5): e60-3. doi:10.1097/BPO.0b013e318221096b - Pubmed citation
- 6. Brown SD, Kasser JR, Zurakowski D et-al. Analysis of 51 tibial triplane fractures using CT with multiplanar reconstruction. AJR Am J Roentgenol. 2004;183 (5): 1489-95. doi:10.2214/ajr.183.5.1831489 - Pubmed citation
- 7. Canale ST, Beaty JH. Campbell's Operative Orthopaedics. Mosby. ISBN:0323072437. Read it at Google Books - Find it at Amazon Chapter 36, 1364-1522
- 8. Marmor L. An unusual fracture of the tibial epiphysis. Clin. Orthop. Relat. Res. 1971;73: 132-5. Pubmed citation