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Best Treatment for Triplanar Ankle Fracture

Q: What is the best treatment for a triplanar ankle fracture?

A: Triplanar ankle fractures typically occur in children aged 10 to 16, with boys between 13 and 15 years and girls between 12 and 14 years being most affected. The difference in age ranges is due to the timing of growth plate closure, which happens earlier in girls than in boys.

The term “triplanar” refers to fractures that occur in three different planes: the sagittal (front-to-back), transverse (side-to-side), and frontal (top-to-bottom) planes. The extent and location of the fracture are influenced by the status of the growth plates, which do not close simultaneously, leaving some areas more vulnerable to fractures.

Treatment decisions are based on two main factors: the reduction of the fracture and the congruity of the joint. Reduction refers to how well the fractured bones can be realigned to their normal position. Surgery is usually required to reposition the bones correctly.

If the bones can be realigned without making an open incision, this is known as a closed reduction, which is performed under general anesthesia. Afterward, the patient is placed in a long leg cast to allow the ankle to heal.

However, if the fracture is still displaced by more than three millimeters after an attempt at closed reduction, the surgeon will likely opt for an open reduction. This involves making incisions as needed to properly align the bones. Metal plates, screws, wires, and pins are then used to secure the bones in place.

In recent years, arthroscopic surgery has become a popular option. Using a small camera (arthroscope) inserted into the joint, the surgeon can achieve better alignment and fixation with less surgical trauma. This method allows for more precise visualization and more accurate restoration of joint congruity.

Reference: Kent A. Schnetzler, MD, MS, and Daniel Hoernschemeyer, MD. The Pediatric Triplane Ankle Fracture. In Journal of the American Academy of Orthopaedic Surgeons, December 2007, Vol. 15, No. 12, Pp. 738-747.