Triplane fracture

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

Mechanism

External rotation is considered to be the main injury mechanism of the tibial type.

Plain radiograph

Due to the aforementioned characteristics the fracture typically appears in routine projections as follows:

Small dislocations and the vertical fracture itself are not infrequently overlooked, why in cases of doubt it is advisable to perform

CT

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.

MRI

may be used to reveal associated ligament injuries and/or (osteo)chondral fractures 7.

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.

The term was coined by L Marmor in 1970 8.

On radiographs, possible consdierations include

Share article

Article information

rID: 10439
Synonyms or Alternate Spellings:
  • Triplanar fracture
  • Triplane fractures
  • Triplanar fractures

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Triplane fracture
    Case 1
    Drag here to reorder.
  • Drag
    Triplane fracture
    Case 1: 3D
    Drag here to reorder.
  • Drag
    Fracture shape an...
    Case 2: with incidental NOF
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.