Question

13 y.o. female with ankle pain following fall down escalator. What's the diagnosis? (Hint: Look very closely)

Answer

Answer: Tri-plane ankle fracture

Tri-plane Fractures (Submitted and written by Dr. Michael Santiago)

• Multi-planar ankle fracture in older children and adolescents during an 18 month window prior to distal tibial-physis closure.
• 3 planes (see Xray below): coronal (A: tibal metaphysis), sagital (B: epiphysis), and transverse (C: growth plate)
• Associated fibular spiral fracture (50% cases)

• Commonly due to external rotational or "twisting" forces.
• Xrays are helpfully, but CT scan may be indicated as fractures may be more displaced than radiographs suggest.
• Non-operative treatment for non-displaced fractures:
  • Closed reduction with long-leg splint/cast
  • Reduction may slip once swelling has subsided
• Indications for operative repair:
  • >2mm displacement of fracture segments
  • Intra-articular fracture