Title: What's the Diagnosis? Case written by Dr. Michael Santiago

Category: Visual Diagnosis

Posted: 6/10/2013 by Haney Mallemat, MD

13 year-old female with ankle pain following fall down escalator. What's the diagnosis?

Answer: Tri-plane ankle fracture

Tri-plane Fractures

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

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)