Triplane fracture

Case contributed by Seamus O'Flaherty
Diagnosis certain


Twisted ankle and cannot weight bear.

Patient Data

Age: 10 years
Gender: Male

A triplane distal tibia fracture is identified. This is characterized by a vertical fracture line that extends through the mid-epiphysis to the ankle joint, a horizontal fracture through the physis and an oblique fracture through the metaphysis that extends to the posterior cortex.

The fracture is minimally displaced by 1 mm. Soft tissue swelling overlying the lateral malleolus noted. No distal fibular or talus fracture.

Normal ankle joint and subtalar joint alignment.

Case Discussion

This is a great example of a triplane fracture. These fractures only occur in adolescents when physiological closure of the distal tibial physeal plate begins on the medial side. The more "open" lateral side is prone to fracture when there is an external rotation and supination mechanism of force.

The fracture appears like a Salter-Harris III fracture on frontal projection and a Salter-Harris II fracture on lateral projection. The name arises from the fact the fracture involves frontal, lateral and transverse planes. 

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