Triplane ankle fracture patterns in paediatric patients

Area of Science:

• Orthopaedic Surgery
• Paediatric Trauma
• Radiology

Background:

• Triplane ankle fractures are complex injuries in adolescents.
• Classic theories link fracture patterns to physeal closure, based on older studies.
• These theories have not been re-evaluated with modern imaging techniques.

Purpose of the Study:

• To investigate the correlation between triplane ankle fracture patterns and the advancing closure of the physis with age.
• To challenge the long-standing assumption that physeal closure dictates triplane ankle fracture patterns.

Main Methods:

• A fracture mapping study of 83 paediatric patients with triplane ankle fractures.
• CT scans were analyzed by a Paediatric Orthopaedic Trauma Surgeon.
• Fracture patterns were qualitatively analyzed using the modified Cole fracture mapping technique and assessed by a panel of six surgeons.

Main Results:

• Fracture maps consistently showed a characteristic Y-pattern, irrespective of patient age.
• No correlation was observed between fracture patterns and the advancing closure of the physis.
• Ligamentous attachments, specifically between the inferior tibiofibular ligaments and the deltoid ligament, were identified as key factors.

Conclusions:

• Triplane ankle fractures exhibit a consistent Y-pattern, not dictated by physeal closure.
• Ligamentous attachments play a more significant role in determining fracture patterns than previously assumed.
• This study challenges established orthopaedic teaching regarding these complex paediatric fractures.