CT of Triplane Fracture
Triplane injuries occur in children approaching skeletal maturity. The fracture occurs in three different planes. A first plane is a sagittal plane extending from the joint, through the epiphysis of the tibia, to the level of the growth plate. After, the fracture changes direction and goes transversely through the growth plate. It then changes direction again and passes in the coronal plane into the posterior tibial metaphysis. Triplane fractures are probably best characterized as a Salter-Harris IV. This can consist of between 2 and 4 fragments. X-rays are often not successful in visualizing the severity of the injury. CT scans help identify the fragments and true relationships. CT also allows a clear view of the joint surface. If the surface is disrupted, open reduction and internal fixation may be required to restore function. Treatment may begin with closed reduction under anesthesia. Percutaneous pinning or cannulated screws are often advocated even with successful closed -reduction. An above-knee cast is applied for 2 to 4 weeks, followed by a BK cast for 2 to 4 weeks. Even with the adequate reduction, the long-term prognosis is not necessarily good.
Intermalleolar Triplane Fracture Preop and Postop Percutaneous Fixation (Below)
CT scans show step off and displacement better. Also, the intra-malleolar nature of the fracture can be visualized.
Postop with percutaneous Screw Fixation
Preop and Postop Xrays of ORIF Triplane Distal Tibia Fracture with FIbula Fracture
Before and After Distal tibia fracture (below)
Pre and Postop Triplane Fracture
CT scan of Triplane Fracture
CT Scan of Intramalleolar Triplane fracture prior to surgery
CT scan of Intermalleolar Triplane Fracture.
3D Reconstruction of Above Fracture