Distal tibial triplane fracture with ipsilateral tibial shaft fracture: A case series

Management of Adolescent Three-Part Lateral Triplane Ankle Fracture with Ipsilateral Shaft of Tibia Fracture and Intact Fibula in COVID Pandemic: A Case Report with Review of Literature

Introduction:

Triplane fracture of ankle is a rare adolescent injury. Its association with ipsilateral tibial shaft fracture is very uncommon in pediatric orthopedic traumatology and rarely reported in the literature till date. Timely diagnosis and management is required to optimize the outcome and avoid complications.

Case Report:

This is a case of a 14-year-old male who sustained a twisting injury to his right leg during early phase of COVID-19 pandemic. He sustained a three-part lateral triplane fracture of the ankle with a concomitant displaced spiral fracture of the shaft of the right tibia. He underwent close reduction under fluoroscopy and above-knee casting for 10 weeks followed patellar tendon weight-bearing cast for 4 weeks. Both fractures healed uneventfully in 14 weeks with patient returning to full activities in 22 weeks.

Conclusion:

The ankle injury in adolescent age group (12–15 years) can easily be missed in the presence of the more obvious tibial fracture and therefore, we recommend ankle assessment of all patients with tibial shaft fractures in this age group both clinically and radiologically.

TREATMENT OF TRIPLANE FRACTURE ANKLE FRACTURES ASSOCIATED WITH IPSILATERAL TIBIAL FRACTURES USING A NOVEL APPROACH

Objective:

The aim of this study is to purpose a novel approach to the concomitant triplanar and tibial shaft fracture.

Methods:

Retrospective study between 2001 and 2019. We collected the patients’ general information, clinical and radiographic data, and complications after the following three-step treatment: (1) fixation of the Salter-Harris II fracture of the triplane fracture, (2) fixation of the Salter-Harris II/IV fracture with cannulated screws, and (3) fixation of the tibial fracture with flexible titanium nails.

Results:

The study included seven patients (six males) with a mean age of 14 years and a mean follow-up of 6.4 years (minimum two years). Five triplane fractures had two fragments and two had three fragments. Five fractures were classified as Salter-Harris II and two as Salter-Harris IV. Three tibial fractures were long oblique, three were spiral, and one had a third fragment. Six fractures affected the middle third and one affected the distal third of the tibia. All triplane and tibial fractures consolidated without significant displacement. No physeal damage was identified.

Conclusions:

This study described the association of tibial fractures with triplane ankle fractures managed by our proposed treatment, which proved to be effective for this fracture association.Level of Evidence IV, Case Series.

Lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture

BACKGROUND

The clinical and imaging features of lower tibial shaft spiral fracture, concurrent with distal tibial triplane fracture, are not clear.

INTRODUCTION

Consequently, this study was aimed to investigate these features for correct diagnosis, treatment, and prevention of possible premature physeal arrest or angular deformation.

METHOD

Patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were enrolled, and the clinical, imaging, treatment, and follow-up data were analyzed.

RESULT

Five patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were found, including four men and one woman with an age range of 12-15 years (mean 13.6). Injury to the distal tibial epiphysis was missed in the diagnosis in plain radiography reports, but careful reevaluation confirmed distal tibial epiphysis fracture in four cases, including Salter-Harris type II in three cases and type III in one case. The remaining case had no apparent distal tibial epiphysis injury in the plain radiograph. CT scan revealed that all five patients had distal tibial triplane fracture of the lateral type, including two fragments in three cases and three fragments in two cases. The fracture was divided into type I(within the articular weight-bearing line) in three cases, type II (outside the articular weight-bearing line) in two cases that were based on the involvement of the articular surface by the fracture line. For the lower tibial fracture, one patient was treated with closed reduction and fixation with an elastic nail, three patients had internal plate fixation, and the remaining patient had cast immobilization. Having followed up for 3-11 months (mean 7), all the distal tibial fractures and the triplane fractures were healed without varus or valgus deformity in the ankle.

CONCLUSION

Distal tibial triplane fracture can be readily missed in plain radiography and should be suspected in patients with distal tibial spiral fracture, which should be evaluated with a computed tomographic scan.