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Unique Ankle Fracture in Young Adolescents

Ankle injuries are on the rise in young teens, most likely due to an increase in sports activity. The triplane ankle fracture is a complex pediatric injury in children ages 12 to 15. This article presents a review of this unique fracture.

The injury pattern includes fractures in three planes of the ankle. These include the sagittal, transverse, and frontal planes. Sagittal refers to a fracture that goes through the bone from front to back. Transverse fractures are from side to side. Frontal describes a fracture from top to bottom.

Trauma or a twisting injury is usually the cause of triplanar ankle fractures. Some growth areas close sooner than others. Theses unevenly closed growth patterns puts some children at risk for this injury.

Boys ages 13 to 15 are the most susceptible. Girls are more likely to have this type of fracture between the ages of 12 to 14 years old. Some of the growth plates close later in males. So they experience triplanar fractures later.

Because these fractures occur during this transitional period between growth and skeletal maturity, triplanar fractures are also called transition fractures. Triplanar fractures do not usually affect children of either sex under the age of 10 or older than 16.

X-rays are an important tool in making the diagnosis. But sometimes only one of the fractures present can be seen on X-rays. CT scans are needed to see the pattern and the full extent of the fracture.

Treatment can be conservative (without surgery) or surgical. Surgery is advised when there is concern about the joint matching on both sides. This is called articular incongruity. Uneven joint surfaces can lead to degenerative arthritis.

If there is no disruption of the joint surface, treatment consists of immobilization with a long leg cast. Most often, the typical triplane fracture requires open surgery to bring the pieces of bone back together. Metal plates, pins, and screws are used to hold everything together until it heals. This operation is called an open reduction and internal fixation (ORIF).

The authors carefully describe when and how to decide whether to use conservative or surgical care. Open versus closed procedures for surgical care is discussed in detail. The importance of accurate reduction of the fractures is stressed.

References: Kent A. Schnetzler, MD, MS, and Daniel Hoernschemeyer, MD. The Pediatric Triplane Ankle Fracture. In Journal of the American Academy of Orthopaedic Surgeons. December 2007. Vol. 15. No. 12. Pp. 738-747.

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