Analysis of 51 tibial triplane fractures using CT with multiplanar reconstruction.

Abstract

We determined the most common patterns of triplane fractures and assessed the risk of epiphyseal separation in each pattern. Fifty-one children with tibial triplane fractures underwent CT, and the resultant scans underwent multiplanar reconstruction. We categorized epiphyseal and physeal involvement, the number of fragments, the appearance of the Salter-Harris fracture in each plane, and the degree of separation of the epiphyseal fragments. The classic two-fragment type of fracture with medial epiphyseal extension occurred most frequently (33/51). All three-fragment types (8/51) of fractures resulted in a separate anterolateral fragment. Extension to the medial malleolus was common (12/51). None of the four reported fractures types involving anteromedial physeal separation was seen. Children with epiphyseal separation requiring surgery were older (odds ratio [OR] = 1.7) and had plafond involvement (OR = 5), CT and multiplanar reconstruction of triplane fractures improve the understanding of patterns of injury and their relative prevalence.