Intramalleolar triplane ankle fractures in adolescents

This article aims to describe a multicenter cohort of atypical triplane ankle fractures with intramalleolar involvement of the epiphysis, providing insights into the affected population, treatment outcomes, and complications. In addition, we propose a treatment strategy for such fractures based on our findings. A retrospective analysis was conducted on adolescent patients diagnosed with triplane ankle fractures. Data from three participating centers in Brazil and Argentina were collected and analyzed. Treatment strategies, including surgical and nonsurgical approaches, were evaluated. Clinical outcomes such as pain levels, functional scores (AOFAS), and return to normal activities were assessed. Radiographic evaluations were performed to evaluate fracture healing and alignment. Data were collected from seven patients with an average age of 13 years. The sample consisted predominantly of male patients (6/7), with the left side affected (6/7) and Shin type 3 fractures. Two cases were treated conservatively, with consolidation within the expected period without subsequent displacements or negative functional repercussions (AOFAS score, 100). In surgical cases, starting fixation from the metaphysis made it possible to avoid fixation of the epiphyseal fragment in all cases, except one. All surgically treated cases had consolidation within the expected time, without subsequent deviations or complications. This multicenter evaluation offers valuable insights into the presentation of fractures, diverse treatment approaches employed, and their respective clinical and radiographic outcomes. However, further prospective studies with larger sample sizes are necessary to validate these findings and to establish evidence-based treatment guidelines for this specific fracture pattern in the adolescent population.