Triplane Distal Tibia Fractures

Pediatric triplane fractures of the distal tibia typically occur in the early teenage years, peaking around 13-14 yrs old and account for about 4-15% of pediatric ankle fractures, are transitional physeal fractures, with asymmetric closure of the distal tibial physis leading to a three-dimensional fracture pattern of an overall Salter-Harris IV fracture that may be 2, 3, or 4 part fractures. Plain radiographs often underestimate the true displacement of fracture fragments, therefore a computed tomography (CT) scan is needed for further evaluation due to the complexity of the fracture. Displacement of >2 mm at the epiphysis generally requires operative management to reestablish articular congruency at the distal tibia and minimizes the risks of degenerative changes and early physeal closure. Fixation typically involves lag screws to reduce fragments and can be performed open or percutaneously. Patients are then casted for 4-6 weeks following fixation before beginning progressive weight bearing.