Review of Distal Tibial Epiphyseal Transitional Fractures

Abstract

The closure of the distal tibial physis occurs over an 18-month period between ages 12 and 15 years. During this time period, children are susceptible to several transitional fractures, so labeled because they are transitioning to skeletal maturity. In the setting of an external rotation force, triplane and Tillaux fractures can occur. These fractures, which present similarly to other Salter-Harris growth plate injuries, do not fit neatly into any 1 classification scheme and are not easily evaluated on plain radiographs. Computed tomography scans are required to optimally assess these fractures and to determine the need for closed vs open treatment. Regardless of which treatment modality is chosen, anatomic reduction is the goal. This article discusses the approach to these unique fractures.

Displaced juvenile Tillaux fractures

“…Some authors prefer ORIF of fractures with more than 2 mm of displacement [11, 19], which is in accordance with the general principles of treatment and was also done in our series. Except for one patient, all patients in our study were treated by ORIF and additional postoperative plaster cast immobilization.…”

Pediatric Triplane Ankle Fractures: Impact of Radiographs and Computed Tomography on Fracture Classification and Treatment Planning

“…Because of their complex fracture pattern, triplane ankle fractures cannot be easily categorized by standard fracture classification schemes 2,4,5 . Classification systems specific to triplane fractures have been developed.…”

Ankle and Foot Injuries in the Young Athlete

“…44 They are twice as common in boys, and the peak incidence is at 8 to 15 years of age. 45 Distal tibial fractures occur during sports requiring pivoting movements and rapid changes in direction. The Salter-Harris (SH) classification is the most common method to describe the fracture.…”

“…Transitional fractures, the triplane, and the Tillaux fractures are only seen in adolescents in a period of 18 months (generally between the ages of 10 and 16 years) when the physis closes in an asymmetric pattern. 45,47 Distal tibial physeal closure begins centrally and then proceeds in an anteromedial direction, then posteromedial, and finally laterally. This pattern of closure predicts the specific tibial physeal patterns seen in adolescent ankle injuries.…”