Answer for BIR CoW 18 Apr 2021
Triplane Fracture
Findings
Xray Mild step off in the lateral half of distal tibial epiphysis with lateral displacement of the fractures epiphyseal fragment . Widening of the lateral distal physeal lucency . CT Sagittally oriented fracture through the epiphysis of the distal tibia and the axial fracture through the growth plate exiting along the lateral aspect with an oblique fracture through metaphysis.
Discussion
Triplane fracture account for only 5-15% of overall paediatric ankle fractures, along with Tillaux fractures, they are the most common ankle fractures in adolescents. They are slightly more common in males. Type of ‘transitional’ ankle fracture which occur almost exclusively in adolescents. Occur during the unique closure pattern of the distal tibial physis. This closes over an eighteen-month period; first in the middle, then medially and finally laterally. During the closure, this area is vulnerable to these distinctive transitional fractures. Occurs at the anterolateral distal tibial epiphysis. It tends to cause avulsion of the tibial fragment by the tibiofibular ligament; this strong ligament extends from the anterior aspect of the lateral distal tibial epiphysis to the anterior aspect of the fibula. The lack of a fracture through the coronal plane distinguishes this injury from that of a triplane fracture. Treatment < 2mm displacement can generally be treated conservatively. This usually involves an above-knee cast for up to 4 weeks (to control the rotational component) followed by either a walker boot or below-knee cast for a further 2-4 weeks. displacement >2mm generally require intervention to ensure articular congruity of the joint surface is restored.
Findings
Xray Mild step off in the lateral half of distal tibial epiphysis with lateral displacement of the fractures epiphyseal fragment . Widening of the lateral distal physeal lucency . CT Sagittally oriented fracture through the epiphysis of the distal tibia and the axial fracture through the growth plate exiting along the lateral aspect with an oblique fracture through metaphysis.
Discussion
Triplane fracture account for only 5-15% of overall paediatric ankle fractures, along with Tillaux fractures, they are the most common ankle fractures in adolescents. They are slightly more common in males. Type of ‘transitional’ ankle fracture which occur almost exclusively in adolescents. Occur during the unique closure pattern of the distal tibial physis. This closes over an eighteen-month period; first in the middle, then medially and finally laterally. During the closure, this area is vulnerable to these distinctive transitional fractures. Occurs at the anterolateral distal tibial epiphysis. It tends to cause avulsion of the tibial fragment by the tibiofibular ligament; this strong ligament extends from the anterior aspect of the lateral distal tibial epiphysis to the anterior aspect of the fibula. The lack of a fracture through the coronal plane distinguishes this injury from that of a triplane fracture. Treatment < 2mm displacement can generally be treated conservatively. This usually involves an above-knee cast for up to 4 weeks (to control the rotational component) followed by either a walker boot or below-knee cast for a further 2-4 weeks. displacement >2mm generally require intervention to ensure articular congruity of the joint surface is restored.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!