Presentation
Right ankle pain and swelling post falling down.
Patient Data
There is a minimally displaced, vertically oriented fracture seen in the distal tibial metaphysis, in addition there is a non-displaced fracture seen in the anterolateral aspect of the distal tibial physis.
Soft tissue swelling is noted anterior to the distal tibia and ankle joint.
There is a complex fracture involving right distal tibial metaphysis and extends down to the medial aspect of the tibial epiphysis and medial malleolus. The mentioned fracture is also involving the anterolateral aspect of the epiphyseal plate.
The fracture is running vertically in the metaphysis, horizontally in the physis and obliquely in the epiphysis with extension to medial malleolus without affecting articular surface or reaching joint space.
Intact distal fibula and tibiofibular syndesmosis. Intact tarsal bones. Intact mortice surface of the talus.
Os trigonum is seen posterior to the talus.
Case Discussion
Appearances, in this case, are compatible with an extra-articular intramalleolar triplane fracture, which is a rare subtype.
The clinical significance of recognizing this fracture is that, although it constitutes an epiphyseal fracture, it remains extra-articular. Unlike the standard triplane fracture that extends through the tibiotalar joint, this variant can be treated non-operatively.