Triplane Fracture

Etiology: Is a transitional fracture of distal tibia in all 3 planes as lateral physis is closing
Imaging: Salter-Harris Type IV fracture consisting of a vertical (sagittal) fracture through epiphysis, a horizontal (axial) fracture through physis, an oblique (coronal) fracture through metaphysis
Imaging Radiograph: Fracture is in sagittal (on AP view), axial and coronal planes (on lateral view)
Imaging CT: Performed to look for displacement of greater than than 2 millimeters at articular surface which requires internal fixation
DDX:
Complications:
Treatment:
Clinical: In adolescents around 13 years old where there is an 18 month window prior to growth plate closure

Radiology Cases of Triplane Fracture

Radiograph and CT of triplane fracture — AP (left upper) and lateral (right upper) radiographs of the ankle show a sagittal fracture through the tibial epiphysis, an axial fracture through the physis, and a coronal fracture through the tibial metaphysis. This is better demonstrated on the coronal (lower left) and sagittal (lower right) CT 2D reconstructions without contrast of the ankle.

CT of a triplane fracture of the ankle — Coronal (left) and sagittal (right) CT 2D reconstructions without contrast of the ankle show a sagittal fracture through the tibial epiphysis, an axial fracture through the physis, and a coronal fracture through the tibial metaphysis.

Radiograph of triplane fracture of the ankle — AP (left), lateral (center) and oblique (right) radiographs of the ankle show a fracture line that is in the sagittal plane on AP view and in the axial and coronal planes on the lateral view.

Radiographs and CT of triplane fracture — AP (above left) and lateral (above right) radiographs of the ankle show a sagittal fracture through the tibial epiphysis, an axial fracture through the physis, and a coronal fracture through the tibial metaphysis. This is better visualized on the coronal (below left) and sagittal (below right) CT 2D reconstructions without contrast of the ankle.