Abstract
Proximal tibial fractures are very rare. Our case is about a six-year-old girl presented with proximal tibial triplane fracture associated with proximal and distal fibula and distal tibial fractures, as a result of a fall of a cement wall on her right knee. A radiograph and computerized tomography (CT) scan were reported as Salter-Harris type III fracture. She was treated by an open reduction and internal fixation by a screw and Kirschner wires. She was followed up for 12 months and showed an excellent knee outcome and her knee range of motion was 10-130o. Anatomical reduction and stable fixation are necessary to prevent future pain, deformity and arthritis. The case demonstrates the efficacy of using an open reduction and internal fixation by a screw and Kirschner wires in treating children with triplane proximal tibial fracture. This type of fracture is not frequently seen and a right diagnosis leads to better management, which could prevent future complications
Highlights
We report a rare case of proximal triplane tibial fracture (SalterHarris type III) associated with distal tibial fracture and proximal and distal fibular fractures
Plain radiography showed proximal tibia fracture classified as Salter-Harris type III and a right distal tibial fracture with valgus and recurvatum angulation (Fig. 1), as well as a segmental fibular fracture
Othman et al reported a similar fracture in a 16-year-old boy who had distal femur and proximal tibia fractures due to motor vehicle collision while the knee in a valgus and hyperextension position [7]
Summary
Proximal tibial fractures are rare and present less than 1% of pediatric fractures. This could be due to the surrounding fibrous structures supporting the knee [1], [2]. Salter-Harris classification is used to classify physical injuries in children [4]. Proximal triplane tibial fractures (Salter-Harris type III) are rare intra-articular fractures [1]. A comprehensive history and physical evaluation are crucial to decide on the appropriate management and to determine the presence or absence of poor prognostic markers such as high-energy trauma and high-grade Salter-Harris injury (type III or IV) [5]. Despite the poor prognosis of this type of fractures as the physis contributes to the length of the limb and the growth of the tibia, our patient did well
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