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Triplane Fracture Review

Triplane Fracture Review. Lapner Nov 2010. Objectives. Background Epidemiology Pathophysiology Diagnosis Treatment Closed Open Management. History. Poland 1898, first detailed description fracture meets a 3-plane geometry transverse sagittal coronal. S-H classification.

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Triplane Fracture Review

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  1. Triplane Fracture Review Lapner Nov 2010

  2. Objectives • Background • Epidemiology • Pathophysiology • Diagnosis • Treatment • Closed • Open • Management

  3. History • Poland 1898, first detailed description • fracture meets a 3-plane geometry • transverse • sagittal • coronal

  4. S-H classification • defies simple Salter-Harris system

  5. Epidemiology • distal tibia second most common site of epiphyseal injury • what is the first? • 10% of pediatric intra-articular ankle injuries • higher incidence in boys • later closure of lateral tibial growth plate

  6. Pathophysiology • characteristic asymmetric closure of physis • central/anteromedial  lateral physis • degree injury based on ossification/energy • “Kump’s hump”

  7. interesting notes • 12-15 years old • transitional fracture • limited dorsiflexion < 10° • predisposes ankle injury sports • fibula fractured 50%

  8. Diagnosis • CT important • planning • diagnosis • displacements

  9. Treatment • Closed • < 2 mm displacement (1mm?) • < 3 mm initialy displacement indication of OR? • extraarticular amenable to non-operative rx

  10. RIF • differing approaches • anterolateral (lateral fractures) • anteromedial • arthroscopic assisted • > 2 mm displacement • long term FU data suggest increased risk degeneration • anatomic reduction reduces risk of physeal injury

  11. RIF method • anterolateral fragment addressed 1st • reduced through AL approach • posteromedial fragment reduced next • (DF IR foot) • AP screw affixing posterior fragment

  12. Post-Op • long leg cast for 3 weeks • short leg cast with progressive weight bearing.

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