Department of Emergency Medicine

UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the diagnosis?

Posted: 5/30/2011 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Question

13 y.o. female with ankle pain following fall down escalator. What's the diagnosis? (Hint: Look very closely)

Answer

Answer: Tri-plane ankle fracture

Tri-plane Fractures (Submitted and written by Dr. Michael Santiago)

  • Multi-planar ankle fracture in older children and adolescents during an 18 month window prior to distal tibial-physis closure.
  • 3 planes (see Xray below): coronal (A: tibal metaphysis), sagital (B: epiphysis), and transverse (C: growth plate)
  • Associated fibular spiral fracture (50% cases)
  • Commonly due to external rotational or "twisting" forces.
  • Xrays are helpfully, but CT scan may be indicated as fractures may be more displaced than radiographs suggest.
  • Non-operative treatment for non-displaced fractures:
    • Closed reduction with long-leg splint/cast
    • Reduction may slip once swelling has subsided
  • Indications for operative repair:
    • >2mm displacement of fracture segments
    • Intra-articular fracture


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