2) Coronal plane - through the posterior metaphysis.
1) Transverse (horizontal) plane - through the growth plate. Triplane (Figure 3) - a Salter-Harris type IV fracture, which occurs in three planes (sagittal, transverse and coronal)įigure 1: Closure of the distal tibial physis begins 1) centrally, followed by 2) medial closure and then 3) lateral closure.įigure 3: In a triplane fracture, the fracture line occurs in three planes.Tillaux fracture (Figure 2) - a Salter-Harris type III fracture involving avulsion of the anterolateral corner of the distal tibial epiphysis (the last portion of the physis to close).They can also be classified by the mechanism or direction of force applied to the injured ankle.ĭue to the asymmetrical closure of the distal tibial physis (Figure 1) during early adolescence, transitional fractures can also occur. Typically requires operative managementĭistal tibial physeal fractures are classified by the Salter-Harris classification. Tillaux and triplane fracture 2 mm displacement If treated operatively, to be arranged by orthopaedic service If treated with closed reduction, fracture clinic within 5 days If reduction not anatomic, discuss with orthopaedic on call serviceįor Salter-Harris type III and IV, refer to orthopaedic on call service Immobilise in above-knee cast, non-weight bearingįor Salter-Harris type III and IV, discuss with orthopaedic on call service whether CT scan is required to confirm that fracture is truly undisplacedĬlosed reduction with above-knee cast, non-weight bearing. Isolated undisplaced distal fibula physeal - Salter-Harris type I and IIįracture clinic within 7-10 days with x-ray
What are the potential complications associated with this injury?.What is the usual ED management for this injury?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?.Tibia fibula shutterstock scapula clavicle.See also: Distal tibia and or fibular physeal fracture
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