Computed Tomography Analysis of Distal Tibia Physeal Fracture Patterns: A Classification and Technique for Optimizing...

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Radiology

Background:

• Tillaux and triplane fractures involve the anterolateral distal tibia and often require surgical intervention for anatomic reduction.
• Current imaging, like CT scans, measures displacement but doesn't fully characterize fracture patterns in the axial plane.
• Axial plane characterization can guide intraoperative fluoroscopic screw trajectory.

Purpose of the Study:

• To analyze and classify the axial plane fracture patterns of pediatric distal tibia fractures (Tillaux and triplane).
• To provide data that can optimize intraoperative screw placement during surgical fixation.

Main Methods:

• Retrospective review of institutional radiology reports for Tillaux or triplane fractures.
• Manual review to identify fractures with anterolateral tibial fragments.
• Measurement of fracture angles and widths in the axial plane, followed by cluster analysis to identify patterns.

Main Results:

• Sixty-nine pediatric patients (average age 16 ± 2 years) with Tillaux (46.4%) or triplane (53.6%) fractures were analyzed.
• Cluster analysis revealed 3 distinct fracture patterns based on angle and width measurements.
• Pattern 1: 24.5° ± 6.5°, Pattern 2: 58.6° ± 7.2°, Pattern 3: 88.6° ± 6.3°, with corresponding fragment widths.

Conclusions:

• This study identifies 3 common, consistent patterns in pediatric distal tibia physeal fractures.
• These identified patterns offer valuable information for optimizing screw starting points and trajectories in the axial plane.
• Guidance is provided for using mortise X-rays and C-arm fluoroscopy during surgical fixation.