Diagnosis and treatment of triplane fractures of the distal tibia in teenagers

Abstract

Objective To investigate the diagnosis, treatment and prognosis of the triplane fractures of distal tibia in the teenagers. Methods From February 2005 to October 2008, 11 young patients with triplane fractures of the distal tibia were treated in our department. They were 8 boys and 3 girls, with an average age of 13.8 (12.5 to 15.3) years. The right ankle was involved in 9 cases and the left in 2. X-ray examination revealed lateral two-fragment tripiane fractures in all the 11 patients, 2 of whom presented with fibular fractures. Six patients were treated with closed reduction and plaster immobilization, while 5 with open reduction and internal fixation (ORIF). Results All the 11 patients had a mean follow-up of 24 (range, 6 to 36) months. The American Orthopaedic Foot & Ankle Society(AOFAS) ankle and hindfoot scale revealed 6 excellent (90 to 100 points) patients, 3 good (75 to 89 points) ones and 2 fair (50 to 74 points) ones. Of the 5 patients treated surgically, 2 experienced superficial infection and partial skin necrosis around the incisions. Conclusions The severity of triplane fracture of the distal tibia in teenagers de-pends on the degree of physis ossification and the magnitude of injury force. Preoperative CT scan and re-construction are essential to an accurate diagnosis and selection of operative approach. ORIF is recommended when the fracture displacement is over 3mm, or when anatomical reduction cannot be achieved and maintained with close treatments. Anatomical reduction is the key to good prognosis. Key words: Adolescent; Tibia; Ankle joint; Fracture