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The Incidence and Treatment Outcome of Atypical Triplane Fractures in Adolescents

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Abstract

Background

Atypical triplane fractures (ATFs) defined as a triplane fracture that did not involve the weight-bearing articulating surface or as an extra-articular triplane fracture. ATFs are scarcely reported and the incidence may be underestimated. Moreover, there is no consensus on treatment. This study aimed to evaluate ATFs incidence, fracture pattern, and treatment outcome, and propose treatment recommendations.

Methods

Twenty-five ATFs of 46 triplane fractures were retrospectively reviewed between 2011 and 2017. ATFs were classified according to the modified ATF classification. Treatment methods were analyzed. Radiologic outcomes were measured based on fracture displacement. Clinical outcomes included the American Orthopedic Foot and Ankle Society score, visual analogue scale, ankle range of motion, and complications at final follow-up period.

Results

A total of 11 type IV, 11 type III, and three type II ATFs were identified. All type II ATFs (intra-articular fracture) were treated with operative treatment. Nine patients were treated with operative treatment and 18 patients were treated with non-operative treatment in type III or IV ATFs (extra-articular fracture). Good radiologic and clinical outcomes were observed in all patients. The residual displacement after initial trial of closed reduction was between 4 and 5 mm in ten cases of type III or IV ATFs; however, no complications were observed, and all cases had good clinical results after non-operative treatment.

Conclusions

ATFs may be under-recognized. Operative treatment and non-operative treatment showed good outcome. Non-operative closed reduction and cast immobilization can be recommended for extra-articular ATF with displacement < 4 mm.

Level of Evidence

Level IV, case series.

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References

  1. Marmor, L. (1970). An unusual fracture of the tibial epiphysis. Clinical Orthopaedics and Related Research, 73, 132–135.

    Article  PubMed  CAS  Google Scholar 

  2. Landin, L. A., et al. (1986). Late results in 65 physeal ankle fractures. Acta Orthopaedica Scandinavica, 57(6), 530–534.

    Article  PubMed  CAS  Google Scholar 

  3. Peterson, H.A., et al., Physeal fractures: Part 1. Epidemiology in Olmsted County, Minnesota, 1979–1988. J Pediatr Orthop, 1994. 14(4): p. 423–430.

  4. Schnetzler, K. A., & Hoernschemeyer, D. (2007). The pediatric triplane ankle fracture. Journal of American Academy of Orthopaedic Surgeons, 15(12), 738–747.

    Article  Google Scholar 

  5. Ogden, J. A., & McCarthy, S. M. (1983). Radiology of postnatal skeletal development. VIII. Distal tibia and fibula. Skeletal Radiology, 10(4), 209–220.

    Article  PubMed  CAS  Google Scholar 

  6. Ertl, J. P., et al. (1988). Triplane fracture of the distal tibial epiphysis. Long-term follow-up. The Journal of Bone & Joint Surgery. American Volume, 70(7), 967–976.

    Article  CAS  Google Scholar 

  7. Spiegel, P. G., et al. (1984). Triplane fractures of the distal tibial epiphysis. Clinical Orthopaedics and Related Research, 188, 74–89.

    Article  Google Scholar 

  8. von Laer, L. (1985). Classification, diagnosis, and treatment of transitional fractures of the distal part of the tibia. Journal of Bone and Joint Surgery. American Volume, 67(5), 687–698.

    Article  Google Scholar 

  9. Yung, C. S., Kuong, E. E., & Chow, W. (2019). A previously unreported type of extra-articular triplane fracture: A revised classification system. Journal of Orthopaedic Surgery (Hong Kong), 27(1), 2309499019828500.

    PubMed  Google Scholar 

  10. Brown, S. D., et al. (2004). Analysis of 51 tibial triplane fractures using CT with multiplanar reconstruction. American Journal of Roentgenology, 183(5), 1489–1495.

    Article  PubMed  Google Scholar 

  11. Shin, A. Y., Moran, M. E., & Wenger, D. R. (1997). Intramalleolar triplane fractures of the distal tibial epiphysis. Journal of Pediatric Orthopedics, 17(3), 352–355.

    Article  PubMed  CAS  Google Scholar 

  12. Thawrani, D., et al. (2011). Reliability and necessity of computerized tomography in distal tibial physeal injuries. Journal of Pediatric Orthopedics, 31(7), 745–750.

    Article  PubMed  Google Scholar 

  13. Kling, T. F., Jr. (1990). Operative treatment of ankle fractures in children. Orthopedic Clinics of North America, 21(2), 381–392.

    Article  PubMed  Google Scholar 

  14. Mann, D. C., & Rajmaira, S. (1990). Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0–16 years. Journal of Pediatric Orthopedics, 10(6), 713–716.

    Article  PubMed  CAS  Google Scholar 

  15. Jones, S., et al. (2003). Triplane fractures of the distal tibia requiring open reduction and internal fixation. Pre-operative planning using computed tomography. Injury, 34(4), 293–298.

    Article  PubMed  CAS  Google Scholar 

  16. Salter, R. B., & Harris, R. (1963). Injuries involving the epiphyseal plate. The Journal of Bone and Joint Surgery. American Volume, 45, 587–622.

    Article  Google Scholar 

  17. Denton, J. R., & Fischer, S. J. (1981). The medial triplane fracture: Report of an unusual injury. Journal of Trauma, 21(11), 991–995.

    Article  PubMed  CAS  Google Scholar 

  18. van Laarhoven, C. J., & van der Werken, C. (1992). “Quadriplane” fracture of the distal tibia: A triplane fracture with a double metaphyseal fragment. Injury, 23(7), 497–499.

    Article  PubMed  Google Scholar 

  19. Ryu, S. M., et al. (2018). Is an operation always needed for pediatric triplane fractures? Preliminary results. Journal of Pediatric Orthopaedics B, 27(5), 412–418.

    Article  Google Scholar 

  20. Kim, J. R., et al. (2010). Treatment outcomes of triplane and Tillaux fractures of the ankle in adolescence. Clinics in Orthopedic Surgery, 2(1), 34–38.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Choudhry, I. K., et al. (2014). Functional outcome analysis of triplane and tillaux fractures after closed reduction and percutaneous fixation. Journal of Pediatric Orthopedics, 34(2), 139–143.

    Article  PubMed  Google Scholar 

  22. Rapariz, J. M., et al. (1996). Distal tibial triplane fractures: Long-term follow-up. Journal of Pediatric Orthopedics, 16(1), 113–118.

    Article  PubMed  CAS  Google Scholar 

  23. Lurie, B., et al. (2020). Functional Outcomes of Tillaux and Triplane Fractures with 2 to 5 Millimeters of Intra-Articular Gap. Journal of Bone and Joint Surgery. American Volume, 102(8), 679–686.

    Article  PubMed  Google Scholar 

  24. O’Connor, D. K., & Mulligan, M. E. (1998). Extra-articular triplane fracture of the distal tibia: A case report. Pediatric Radiology, 28(5), 332–333.

    Article  PubMed  CAS  Google Scholar 

  25. Kay, R. M., & Matthys, G. A. (2001). Pediatric ankle fractures: Evaluation and treatment. Journal of American Academy of Orthopaedic Surgeons, 9(4), 268–278.

    Article  CAS  Google Scholar 

  26. Barmada, A., Gaynor, T., & Mubarak, S. J. (2003). Premature physeal closure following distal tibia physeal fractures: A new radiographic predictor. Journal of Pediatric Orthopedics, 23(6), 733–739.

    Article  PubMed  Google Scholar 

  27. Schurz, M., et al. (2010). Physeal injuries of the distal tibia: Long-term results in 376 patients. International Orthopaedics, 34(4), 547–552.

    Article  PubMed  Google Scholar 

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Funding

This work was supported by a research grant from of Jeju National University Hospital in 2020 (202000390001).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Jeju National University Hospital, 15 Aran 13-gil, Jeju, 63241, Korea

    Hyunseong Kang, Taehan Kang & Chaemoon Lim

Authors
  1. Hyunseong Kang
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  2. Taehan Kang
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  3. Chaemoon Lim
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Contributions

Study design: CL and HK. Data acquisition: CL and TK. Data analysis: CL and TK. Drafting of manuscript: CL and HK. Review and editing of manuscript: CL, TK, and HK.

Corresponding author

Correspondence to Chaemoon Lim.

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Conflict of Interest

All authors declare that they have no conflict of interest.

Ethical Approval

This retrospective study was conducted in accordance with the relevant guidelines and regulations outlined in the Declaration of Helsinki, and was approved by the institutional review board (IRB) of our hospital (IRB Approval No.: 2020-01-009).

Informed Consent

The requirement for informed consent was waived by the IRB of our hospital owing to the retrospective nature of this study.

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Kang, H., Kang, T. & Lim, C. The Incidence and Treatment Outcome of Atypical Triplane Fractures in Adolescents. JOIO 56, 2133–2140 (2022). https://doi.org/10.1007/s43465-022-00679-4

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  • DOI: https://doi.org/10.1007/s43465-022-00679-4

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