CASE 73
By: Dr. Amna Kashgari MD,SSC-Rad
HISTORY: A 5-years-old boy with a history of trauma.
What are your findings?
What is your differential diagnosis?
What is your diagnosis?
FINDINGS:
Frontal and lateral radiographs of the ankle joint (A) demonstrate a vertical fracture through the epiphysis of the tibia. Lateral radiograph of the ankle shows oblique fracture through the metaphysis extending to the growth plate.
Sagittal (B) and coronal (C) CT reformatted images for the right ankle show minimally displaced fracture extending from the posterior metaphysis of the tibia to the epiphysis.
DIFFERNTIAL DIAGNOSIS:
Triplane fracture.
Tillaux fracture.
DIGNOSIS:
Triplane fracture.
PEARLS AND DISCUSSION:
The component of the Triplane fracture of the distal tibia are:
vertical fracture through the epiphysis (on AP film or coronal plan).
horizontal fracture through the physis.
oblique fracture through the metaphysis (on lateral film or sagittal plan).
Fracture mechanism:
It occurs in adolescent’s secondary to external rotation of the ankle joint. As the lateral physeal plate is still open at that age, this type of the fracture affects it.
It involves the posterolateral epiphysis and the posterior metaphysis of the distal tibia.
Classification:
Two-part fracture: Most common, it affects the posterolateral epiphysis and the posterior metaphysis, while the anteromedial epiphysis attached to the tibial shaft.
Three-part fracture: Rectangular fragment of distal tibial epiphysis, a large fragment that includes the remainder of the epiphysis with a metaphyseal spike, and the tibial shaft.
Imaging features:
Plain AP and Lateral X-ray of the ankle:
Appear like Salter-Harris III fracture on AP views.
Appear like Salter-Harris II fracture on lateral views.
The fracture is Salter Harris type IV fracture.
CT scan:
Extent of injury and displacement for surgical planning.
Association:
Spiral fibula fracture.
FURTHER READING:
Stephen D. Brown, James R. Kasser et al. Analysis of 51 Tibial Triplane Fractures Using CT with Multiplanar Reconstruction.
Lane F Donnelly. Fundamental of pediatric radiology. ISBN-13: 978-0721690612
Johan G Blickman, Bruce R Parker, Patrick D Barnes. Pediatric Radiology: The Requisites, 3e. ISBN-10: 0323031250
