Triplane Fracture of the Proximal Tibia: A Case Report and Literature Review

Abstract

Background The triplane fracture, a unique transitional physeal injury, is classically described in the distal tibia. A small number of additional anatomic locations are documented in the orthopaedic literature. Methods Available literature surrounding triplane fractures was reviewed. We describe a rare case of a proximal tibial triplane fracture in a thirteen-year-old girl, suffered during a skiing accident. Results Using arthroscopically assisted percutaneous reduction techniques an anatomic reduction was achieved. Conclusion We outline the surgical and postoperative techniques for management of this unique injury.

Triplane fracture of the proximal tibia: a case report and literature review

“…In distal tibia, the triplane fracture occurs due to the asymmetrical closure of the physis, from central to antero-medial to posteromedial and finishing with closure of the lateral margin of the physis. The proximal tibial physis has a more symmetrical closure, which may explain the rarity of a triplane fracture in this location [5]. Another theory in favor of this rare situation is related to the attachments of the medial and lateral collateral ligaments which result in the stresses from the knee being transmitted to the metaphysis and not the epiphysis [3].…”

“…In practical terms, most triplane fracture are easily diagnosed by plain film radiography. The value of Computed Tomography(CT) especially 3D reconstruction for defining the injury pattern and preoperative planning in these rare and technically demanding cases is highlighted [3, 5]. In triplane fractures involving the proximal tibia, the Magnetic Resonance Imaging (MRI) scan has probably more significant value than the CT scan, as tibial plateau fractures may be associated with cruciate ligament and meniscal tears [9].…”

“…According to some authors [9, 10] the control of the reduction can be performed by knee arthroscopy. The advantages of this arthroscopic reduction are complete evacuation of hemarthrosis, diagnostic evaluation of the cruciate ligaments, the meniscus and the metaphyseal part of the fracture lines extend through the physis into the epiphysis and the joint [4, 5]. A cast immobilization is recommended for at last 6 weeks to prevent secondary displacement and obtain a good consolidation.…”

“…Triplane fractures are known in the distal part of the tibia and were first described by Lynn in 1972 [1]. Triplane fractures in the proximal tibia are far less common than those in the distal tibial end, as was demonstrated in the current orthopaedics literature [2-5]. Diagnosis is generally easy with CT scan and treatment is most often surgical, especially in displaced fractures.…”

Concomitant Tibia Shaft and Distal Triplane Fractures

“…Recently a limited number of new cases suffering from ipsilateral tibia shaft and distal triplane fracture have been presented. They were all recorded in adolescents [42][43][44][45][46][47] .…”