• Figure 1 shows anteroposterior (AP) (Fig. 1A), mortise (Fig. 1B), and lateral (Fig. 1C) radiographs of a three-part triplane fracture. • Figure 2 shows AP (Fig. 2A), mortise (Fig. 2B), and lateral (Fig. 2C) radiographs of an extra-articular medial triplane fracture. • Coronal (Fig. 3) and axial views should be used to accurately measure displacement (stepoff and gap) of the distal tibial articular surface. • Furthermore, coronal, axial, and sagittal CT views enable the surgeon to preoperatively plan the placement of internal fixation (i.e., screw trajectory) based on the fracture pattern, thus allowing for limited exposure of the fracture fragments. Figure 4 illustrates the use of axial CT images in surgical planning of screw placement at the epiphyseal (Fig. 4A) and metaphyseal (Fig. 4B) levels. Pearls
Triplane Fractures
Examination/Imaging
Intra-articular triplane fractures of the distal tibia are anatomically complex Salter-Harris IV fractures usually consisting of a coronal fracture line in the metaphysis, a transverse fracture line within the physis, and a sagittal, intra-articular fracture through the epiphysis. On the anteroposterior (AP) view, the fracture appears to be a Salter-Harris III fracture; on the lateral view, it appears to be a Salter-Harris II fracture.
Computed tomography (CT) permits identification of the number and location of fracture fragments.
Positioning
The patient is placed in the supine position on a radiolucent operating table with a bump under the ipsilateral hip to internally rotate the limb and permit easy medial and lateral access to the ankle (Fig. 6).
A nonsterile tourniquet is placed around the ipsilateral thigh.
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44: Triplane Fractures
