Journal of Musculoskeletal Trauma

Extra-articular Triplane Fracuture of the Distal Tibia in Children: Yeo Hun Yun, Hoon Jeong, Yi Kyoung Shin, Sung Gu Yeo; J Korean Fract Soc 2005;18(4):459-461. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.459

Abstract PDF: PURPOSE
To demonstrate the effectiveness of the conservative treatment which was introduced to the extraarticular triplane fractures of the distal tibia.
MATERIALS AND METHODS
We reviewed radiographs and medical records of eight patients with extraarticular triplane fractures of the tibia. Four patients were treated with closed reduction and internal fixation and the others with closed reduction and plaster.
RESULTS
In all patients, the union of fractures was obtained. Although the physes were closed early, there was no angular deformity or leg length discrepancy.
CONCLUSION
In case of extraarticular triplane fracture, except for open fracture or failure of closed reduction, conservative treatment yield good result.

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Triplane Fracture of the Distal Tibial Epiphysis: Jin Hwan An, Jae Keun So, Jae Chul Ok; J Korean Soc Fract 1995;8(4):870-877. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.870

Abstract PDF: The triplane fracture of the distal end of the tibia in adolescents is considered uncommon injuries, but recently it has received considerable attention in the orthopaedic literature. We reviewed five patients who had been treated at Kyung Hee University Hsopital for triplane fractures and followed up at least one year. The purposes of this paper were to determine the configuration of the fracture and the results of treatment. The cause of injury was slip down in three patients, fall down in one patients and sports injury in one patient. The mechanism of injury was supination-external rotation in four patients and unknown in one patient. The plain x-ray and CT were evaluated in all patients. On radiological evaluation, the initial displacement more than 2mm observed in four patients, but displaced fractures were reduced less than 2mm after treatment. The two fragment fractures were seen in two patients, three fragments in three patients. At last follow-up, complete union with anatomical position occurred without degenerative change of ankle joint and any deformity. We treated operatively in two patients, one with arthroscopic reduction and percutaneous pinning, the other with open reduction and internal fixation. Also we treated conservatively in one minimal displaced fracture and two displaced fractures. The results were graded using a modification of the Weber protocol. Points were assigned for pain, walking, activity, radiographic findings, function of the ankle joint, and deformity. The results was classified as excellent in 5 patients and good, fair and poor results was none. The complications was not developed in atl patients. The initial displacement, No. of fragments and treatment method were not significantly affect the results of treatment. Finally, we had excellent results in triplane fracture if the reduction less than 2mm regardless initial displacement can obtained.

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Analsis of the Distal Tibial Physeal and Epiphyseal Injury: In Ho Choi, Choon Ki Lee, Duk Yong Lee, Se Il Suk, Song Choi, Yong Hoon Kim, Suk Kee Tae, Seong Il Kim; J Korean Soc Fract 1989;2(2):164-173. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.164

Abstract PDF: We have reviewed 21 cases of physeal and epiphyseal fracture of the distal tibia including one case of juvenile Tillaux fracture and four cases of triplane fracture. The patterns of fracture were correlated with the mechanism of injury using the modified Lauge-Hansen method and sysemic classification of the triplane frature was proposed. Treatment included closed reduction and cast(9 cases), closed reduction and percutaneous pin fixation(4 cases), and open reduction(8 cases). Two of the nine patients treated by means of closed reduction and cast had ankle joint incongruity or progressive varus deformity requiring corrective ost eotomy. These two patients had either Salter-Harris Type III ro Type IV fracture after supination-inversion injury. In one patient, who had 100 per cent displacement of the distal tibial epiphysis and degloving injury of the ankle, premature physeal arrest developed after open reduction and internal fixaion for Salter-Harris Type Tyre I fracture. If there are triagular metaphseal ledge along with the juvenile Tillaux fracture-like vertical epiphyseal fracture line on the antero-posterior view and Salter-Harris Type II or Type IV frature on the lateral view, a certain type of triplane fracture is strongly suggested. Plain radiographs, however, could not accurately demontrate the detailed configuration of the triplane fracture, instead computerized axial tomography was very helpful us to analyse the true dimensions of the triplane fracture. We agree that displace Salter-Harri Type III or Type IV and transitional fractures with a fracture gap of more than two millimeters in the weight-bearing portion of the epiphysis regure open reduction.

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