Analysis of 51 tibial triplane fractures using CT with multiplanar reconstruction.

OBJECTIVE: We determined the most common patterns of triplane fractures and assessed the risk of epiphyseal separation in each pattern.

MATERIALS AND METHODS: Fifty-one children with tibial triplane fractures underwent CT, and the resultant scans underwent multiplanar reconstruction. We categorized epiphyseal and physeal involvement, the number of fragments, the appearance of the Salter-Harris fracture in each plane, and the degree of separation of the epiphyseal fragments.

RESULTS: The classic two-fragment type of fracture with medial epiphyseal extension occurred most frequently (33/51). All three-fragment types (8/51) of fractures resulted in a separate anterolateral fragment. Extension to the medial malleolus was common (12/51). None of the four reported fractures types involving anteromedial physeal separation was seen. Children with epiphyseal separation requiring surgery were older (odds ratio [OR] = 1.7) and had plafond involvement (OR = 5),

CONCLUSION: CT and multiplanar reconstruction of triplane fractures improve the understanding of patterns of injury and their relative prevalence.