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Age: 15

Sex: Male

Indication: Ankle injury

Save ("V")

Case #11


Findings

  • Acute three-part Salter IV fracture of the distal tibia including a sagitally-oriented fracture of the distal tibial epiphysis, horizontal extension into the lateral aspect of the distal tibial physis, and continuation as a nondisplaced fracture extending vertically into the distal tibial metaphysis
  • Additional 7 mm fracture fragment adjacent to the medial malleolus
  • Ankle joint effusion
  • Extensive soft tissue swelling about the ankle
  • Os trigonum


Diagnosis

  • Triplane fracture

Sample Report

Acute three-part Salter IV fracture of the distal tibia including a sagitally-oriented fracture of the distal tibial epiphysis, horizontal extension into the lateral aspect of the distal tibial physis, and continuation as a nondisplaced fracture extending vertically into the distal tibial metaphysis (triplane fracture). Consider CT for further characterization.

Additional 7 mm fracture fragment adjacent to the medial malleolus consistent with chip/avulsion fracture.

Ankle joint effusion.

Extensive soft tissue swelling about the ankle.

Os trigonum, anatomic variant.


Discussion

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Images

Red arrow: vertical fracture through the epiphysis. Yellow arrow: horizontal fracture through the lateral physis. Note that the medial physis is fused. Blue arrow: chip fracture along the medial malleolus. Lateral view shows subtle fracture continuation into the distal tibial metaphysis (red arrows). Anterior view 3D reformat from the patient's subsequent CT shows the epiphyseal (red arrow) and physeal (yellow arrow) fracture components. Posterior view 3D reformat from the patient's subsequent CT shows the triangular metaphyseal fracture component. Followup radiographs after ORIF in this patient. Typical triplane fracture fragment morphology.



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