The pediatric triplane ankle fracture.

Area of Science:

• Orthopedic Surgery
• Pediatric Traumatology
• Skeletal Development

Background:

• The pediatric triplane ankle fracture is a distinct injury pattern not fully captured by the Salter-Harris classification.
• It arises from the asymmetric closure of the distal tibial physis, a process unique to the pediatric population.
• This transitional injury involves multiplanar fracture components and variations.

Purpose of the Study:

• To describe the characteristics, presentation, and management of pediatric triplane ankle fractures.
• To highlight the unique nature of these injuries in the pediatric population.
• To emphasize the importance of accurate reduction in surgical management.

Main Methods:

• Review of literature on pediatric triplane ankle fractures.
• Analysis of fracture patterns and classification challenges.
• Discussion of treatment modalities based on fracture displacement and intra-articular involvement.

Main Results:

• Triplane ankle fractures represent 5-10% of pediatric intra-articular ankle injuries, typically seen in 12-15 year olds.
• Nondisplaced or extra-articular fractures are managed non-operatively with casting.
• Displaced fractures require open reduction and internal fixation, with a goal of intra-articular reduction within 2 mm.

Conclusions:

• Pediatric triplane ankle fractures are complex injuries requiring specific diagnostic and management considerations.
• Optimal outcomes depend on achieving precise intra-articular reduction, especially in displaced fractures.
• Understanding the mechanism of asymmetric physeal closure is key to recognizing and treating these fractures.