Analysis of 51 Tibial Triplane Fractures Using CT with Multiplanar Reconstruction
Stephen D. Brown1,
James R. Kasser2,
David Zurakowski2 and
Diego Jaramillo3
1 Department of Radiology, Children's Hospital, 300 Longwood Ave., Boston, MA
02115.
2 Department of Orthopaedic Surgery, Children's Hospital, Boston, MA
02115.
3 Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
19104.
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Fig. 1A. —Illustrations of two- and three-fragment triplane fractures
as classically described in literature. In classic lateral two-fragment
fracture, posterolateral fragment, consisting of posterolateral epiphysis and
posterior metaphysis, separates from anteromedial epiphysis, which remains
attached to tibial shaft.
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Fig. 1B. —Illustrations of two- and three-fragment triplane fractures
as classically described in literature. In classic medial three-fragment
fracture, separation of physis at Kump's bump results in one free
anterolateral epiphyseal fragment, one fragment that involves rest of
epiphysis and posterior metaphysis, and one main fragment corresponding to
remaining tibial metaphysis and shaft.
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Fig. 1C. —Illustrations of two- and three-fragment triplane fractures
as classically described in literature. In three-fragment fracture without
separation at Kump's bump, there is one fragment consisting of posterior
epiphysis, posterior metaphysis, and seperate anterolateral epiphyseal
fragment. Anteromedial epiphysis remains attached to anterior tibial
metaphysis.
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Fig. 2A. —Fracture patterns through epiphysis encountered in triplane
fractures. Axial (A) and 3D reconstructed (B) CT images obtained
in 13-year-old boy show most common epiphyseal fracture
pattern—two-fragment fracture in which fracture first runs
anteroposteriorly and then courses medially around Kump's bump anteriorly.
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Fig. 2B. —Fracture patterns through epiphysis encountered in triplane
fractures. Axial (A) and 3D reconstructed (B) CT images obtained
in 13-year-old boy show most common epiphyseal fracture
pattern—two-fragment fracture in which fracture first runs
anteroposteriorly and then courses medially around Kump's bump anteriorly.
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Fig. 2C. —Fracture patterns through epiphysis encountered in triplane
fractures. Axial CT image obtained in 14-year-old boy shows two-fragment
fracture in which epiphyseal fracture courses laterally without coursing
medially. In axial plane, this type of fracture is indistinguishable from
juvenile Tillaux fracture; it occurred only once in this series.
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Fig. 2D. —Fracture patterns through epiphysis encountered in triplane
fractures. Axial CT image obtained in 12-year-old girl shows common
three-fragment fracture, in which fracture extends medially and laterally.
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Fig. 3A. —Extraarticular–Intramalleolar triplane fracture in
15-year-old boy. Axial (A), sagittal (B), and coronal
reformations (C) and coronal 3D reconstruction (D) show triplane
fracture of right ankle that traverses physis and exits through medial
malleolus, without involving plafond.
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Fig. 3B. —Extraarticular–Intramalleolar triplane fracture in
15-year-old boy. Axial (A), sagittal (B), and coronal
reformations (C) and coronal 3D reconstruction (D) show triplane
fracture of right ankle that traverses physis and exits through medial
malleolus, without involving plafond.
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Fig. 3C. —Extraarticular–Intramalleolar triplane fracture in
15-year-old boy. Axial (A), sagittal (B), and coronal
reformations (C) and coronal 3D reconstruction (D) show triplane
fracture of right ankle that traverses physis and exits through medial
malleolus, without involving plafond.
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Fig. 3D. —Extraarticular–Intramalleolar triplane fracture in
15-year-old boy. Axial (A), sagittal (B), and coronal
reformations (C) and coronal 3D reconstruction (D) show triplane
fracture of right ankle that traverses physis and exits through medial
malleolus, without involving plafond.
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Fig. 4. —Separation at Kump's bump. Coronal reformation of right ankle
shows subtle fracture though epiphysis at Kump's bump in 12-year-old girl with
partially fused physis.
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Fig. 5A. —Reformatted CT images in 14-year-old girl can show appearance
of characteristic Salter-Harris fracture patterns emulated in triplane
fractures. Sagittal reformation of lateral aspect of ankle shows coronal-plane
fracture though posterior tibial metaphysis that appears to have configuration
of Salter-Harris type II fracture.
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Fig. 5B. —Reformatted CT images in 14-year-old girl can show appearance
of characteristic Salter-Harris fracture patterns emulated in triplane
fractures. Sagittal reformation through medial aspect of ankle appears to
conform to Salter-Harris type IV fracture, with coronal-plane fracture
extending though growth plate and into plafond.
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Fig. 5C. —Reformatted CT images in 14-year-old girl can show appearance
of characteristic Salter-Harris fracture patterns emulated in triplane
fractures. Coronal reformatted image shows sagittal-plane intraarticular
fracture of ankle though epiphysis that has appearance of Salter-Harris type
III fracture.
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Fig. 5D. —Reformatted CT images in 14-year-old girl can show appearance
of characteristic Salter-Harris fracture patterns emulated in triplane
fractures. Three-dimensional reconstruction shows sagittal-plane fracture of
ankle through anterior aspect of epiphysis as well as edge of posterior tibial
metaphyseal fracture that is attached to anterolateral epiphysis. This is most
common triplane fracture pattern.
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Copyright © 2004 by the American Roentgen Ray Society.
