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Strohm JA, Schubert I, Schneidmüller D, Strohm PC. Is cross-sectional imaging necessary for fractures of the distal lower leg in children and adolescents: results of a nationwide survey. Eur J Trauma Emerg Surg 2024; 50:2641-2647. [PMID: 37872263 PMCID: PMC11666642 DOI: 10.1007/s00068-023-02379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE In childhood and adolescence, cross-sectional imaging, most commonly computed tomography (CT), is often performed for advanced diagnosis of joint injuries of the distal lower leg and upper ankle. Due to radiation exposure, the need for CT remains controversial, as these injuries follow stereotypies and usually have a similar course. Alternatively, the performance of magnetic resonance imaging (MRI) is also discussed. Since radiation sensitivity at this young age is much higher than in adults, an effort must be to minimize radiation exposure according to as low as reasonably achievable (ALARA) principles. The aim of this survey is to evaluate the current procedure in Germany in the diagnosis of pediatric injuries of the distal lower leg and upper ankle. METHODS For data collection, a survey entitled "CT in fractures of the ankle joint in childhood and adolescence: subject of the survey are injuries between 8 and 15 years of age" of the Section of Pediatric Traumatology in the German Association of Trauma Surgery was sent to all members via the distribution list of the German Society of Orthopedics and Traumatology and the distribution list of the German Society of Pediatric Surgery in a period from September 20, 2022-December 21, 2022. The survey included a total of 21 questions. Target groups were trauma and pediatric surgeons and orthopedic surgeons working in the hospital and in practice. RESULTS A total of 525 participants took part in the survey: ultrasound diagnostics are used by almost 25% and the Ottawa Ankle Rules by over 50% always or in most cases. A conventional x-ray is always or most often used by over 90%. CT imaging is rarely used by 88.57%, mainly for surgical planning or analysis of fracture progression. 69.9% report that their radiology department uses a pediatric protocol for CT exams; 25.71% do not know if this is the case. MRI imaging is also used infrequently by 89.33%, mostly to identify associated injuries. Overall, CT imaging is chosen by 55.62% and MRI imaging by 35.24% as the sectional imaging modality for suspected fractures; 95.05% consider sectional imaging useful for a triplane fracture, 59.24% for a two-plane fracture, 41.71% for a Salter-Harris type III/IV injury, and 8% for a Salter-Harris type I/II injury. CONCLUSION The survey showed that the conventional X-ray is still the gold standard. Interestingly, more than half of the respondents regularly use the Ottawa Ankle Rules, and diagnostics using ultrasound are also used by almost a quarter. Awareness of radiation protection in children exists, although a quarter of all participants do not know the extent to which their radiology department has a specific pediatric protocol for CT imaging. Cross-sectional imaging is performed on a regular basis. Regarding the actual extent of imaging, there is a clear divergence between theory and practice.
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Affiliation(s)
- Jonas Alexander Strohm
- Department of Orthopedic and Trauma Surgery, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Ilona Schubert
- Clinic for Orthopedics and Trauma Surgery, Klinikum Bamberg, Buger Straße 80, 96049, Bamberg, Germany
| | - Dorien Schneidmüller
- Department of Trauma Surgery, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau Am Staffelsee, Germany
| | - Peter Christian Strohm
- Department of Orthopedic and Trauma Surgery, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
- Clinic for Orthopedics and Trauma Surgery, Klinikum Bamberg, Buger Straße 80, 96049, Bamberg, Germany
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Greenhill DA, Mundluru SN, Gomez RW, Romero J, Riccio AI. Metaphyseal Fracture Displacement is Predictive of Intra-articular Diastasis in Adolescent Triplane Ankle Fractures. J Pediatr Orthop 2024; 44:94-98. [PMID: 37779308 DOI: 10.1097/bpo.0000000000002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Triplane fractures are rare enough that large homogeneous series to support management decisions are lacking. During initial evaluation, the addition of computed tomography (CT) to conventional X-rays (XR) does not always alter the patient's clinical course. Therefore, routine use of CT is controversial. This study aims to: (1) clarify quantitative relationships between articular displacement measured on XR versus CT and (2) identify whether metaphyseal displacement on the lateral XR predicts clinically relevant articular displacement on a CT scan. METHODS A 10-year retrospective review of consecutive triplane fractures was performed at a level 1 pediatric trauma center. Maximum articular and metaphyseal displacement were recorded from XR and CT. Quantitative relationships between XR and CT measurements were compared among imaging modalities and radiographically operative versus nonoperative fractures. RESULTS Eighty-seven patients met the inclusion criteria. XR underestimated articular displacement by 229% in the sagittal plane (1 mm on XR vs 3.3 mm on CT; P < 0.05) and 17% in the coronal plane (2.3 mm on XR vs 2.7 mm on CT; P < 0.05). XR underestimated articular step-off by 184% in the coronal plane and 177% in the sagittal plane ( P < 0.05). CT measurements more often differentiated patients who did or did not undergo surgery at our institution. Metaphyseal displacement was significantly higher in patients with traditionally operative articular displacement (≥2.5 mm on CT) versus those with articular displacement below traditionally operative thresholds (2.4 vs 0.9 mm, P = 0.001). Sixty patients had metaphyseal displacement >1 mm on the lateral XR, of whom 56 had surgical-magnitude articular displacement (≥2.5 mm) on CT (positive predictive value = 94%). CONCLUSIONS Conventional radiographs underestimate the true articular displacement of triplane fractures. Surgical-magnitude articular step-off is rare, and the largest articular gap is usually visualized on the axial CT image. Metaphyseal displacement >1 mm, which is easily measured on a lateral XR, is strongly predictive of clinically relevant articular displacement on CT. This radiographic finding should prompt advanced imaging before proceeding with nonoperative management. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dustin A Greenhill
- Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA
| | - Surya N Mundluru
- Department of Orthopedic Surgery, University of Texas Houston McGovern School of Medicine, Houston
| | - Robert W Gomez
- Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA
| | - Joseph Romero
- Department of Orthopedic Surgery, University of Texas Southwestern
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Prijs J, Rawat J, Ten Duis K, IJpma FFA, Doornberg JN, Jadav B, Jaarsma RL. Triplane ankle fracture patterns in paediatric patients. Bone Joint J 2023; 105-B:1226-1232. [PMID: 37909160 DOI: 10.1302/0301-620x.105b11.bjj-2023-0204.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims Triplane ankle fractures are complex injuries typically occurring in children aged between 12 and 15 years. Classic teaching that closure of the physis dictates the overall fracture pattern, based on studies in the 1960s, has not been challenged. The aim of this paper is to analyze whether these injuries correlate with the advancing closure of the physis with age. Methods A fracture mapping study was performed in 83 paediatric patients with a triplane ankle fracture treated in three trauma centres between January 2010 and June 2020. Patients aged younger than 18 years who had CT scans available were included. An independent Paediatric Orthopaedic Trauma Surgeon assessed all CT scans and classified the injuries as n-part triplane fractures. Qualitative analysis of the fracture pattern was performed using the modified Cole fracture mapping technique. The maps were assessed for both patterns and correlation with the closing of the physis until consensus was reached by a panel of six surgeons. Results Fracture map grouped by age demonstrates that, regardless of age (even at the extremes of the spectrum), the fracture lines consolidate in a characteristic Y-pattern, and no shift with closure of the physis was observed. A second fracture map with two years added to female age also did not show a shift. The fracture map, grouped by both age and sex, shows a Y-pattern in all different groups. The fracture lines appear to occur between the anterior and posterior inferior tibiofibular ligaments, and the medially fused physis or deltoid ligament. Conclusion This fracture mapping study reveals that triplane ankle fractures have a characteristic Y-pattern, and acknowledges the weakness created by the physis, however it also challenges classic teaching that the specific fracture pattern at the level of the joint of these injuries relies on advancing closure of the physis with age. Instead, this study observes the importance of ligament attachment in the fracture patterns of these injuries.
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Affiliation(s)
- Jasper Prijs
- Department of Orthopaedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Jaideep Rawat
- Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
- Department of Orthopaedics, Women's and Children's Hospital, Adelaide, Australia
| | - Kaj Ten Duis
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Surgery, Groningen University Medical Centre, Groningen, The Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Bhavin Jadav
- Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
| | - Ruurd L Jaarsma
- Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia
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Visualization of complicated fractures by 3D-printed models for teaching and surgery: hands-on transitional fractures of the ankle. Eur J Trauma Emerg Surg 2022; 48:3923-3931. [PMID: 35122507 PMCID: PMC9532304 DOI: 10.1007/s00068-022-01879-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022]
Abstract
Aims Understanding the orientation of fracture lines and mechanisms is the essential key to sufficient surgical therapy, but there is still a lack of visualization and teaching methods in traumatology and fracture theory. 3D-printed models offer easy approach to those fractures. This paper explains the use of the teaching possibility with 3-dimensional models of transitional fractures of the ankle. Methods and results For generating 3D printable models, already obtained CT data were used and segmented into its different tissues, especially parts concerning the fracture. After the segmentation process, the models were produced with FFF (fused filament fabrication) printing technology. The fracture models then were used for hands-on teaching courses in AO course (Arbeitsgemeinschaft für Osteosynthesefragen) of pediatric traumatology in 2020 in Frankfurt. In the course fracture anatomy with typical fracture lines, approaches, and screw placement could be shown, discussed and practiced. Conclusion The study shows the use of 3D-printed teaching models and helps to understand complicated fractures, in this case, transitional fractures of the ankle. The teaching method can be adapted to numerous other use cases. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01879-1.
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Tarallo L, Micheloni GM, Mazzi M, Rebeccato A, Novi M, Catani F. Advantages of preoperative planning using computed tomography scan for treatment of malleolar ankle fractures. World J Orthop 2021; 12:129-139. [PMID: 33816140 PMCID: PMC7995337 DOI: 10.5312/wjo.v12.i3.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/07/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Malleolar ankle fractures have been classified using plain radiographs, and there is no consensus regarding the role of computed tomography (CT) scans in preoperative planning. We analyzed critical aspects, such as limits of standard radiographs, types of injury, classification methods and cost/benefit evaluations. CT scans allow a 3D analysis of the fracture to be obtained and consequently assess the indication for surgical procedure, surgical access and the type of fixation devices required. This exam is useful for detecting lesions that may go unnoticed on radiographs and will help surgeons to clarify the pathoanatomy of ankle fractures. According to Arbeitsgemeinschaft fur Osteosynthesefragen/ Orthopaedic Trauma Association (AO/OTA) classification, CT scan is recommended in medial malleolar fractures with vertical rim, type 44B fractures with posterior malleolar involvement and all type 44C fractures (according to AO/OTA). Also Tillaux-Chaput fractures (43-B1 according to AO/OTA), malleolar fractures in the presence of distal tibial fractures (43 according to AO/OTA) and distal tibia fractures in adolescents should be studied with CT scans.
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Affiliation(s)
- Luigi Tarallo
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Gian Mario Micheloni
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Michele Mazzi
- Dipartimento di Chirurgia, AULSS8 Berica-Ospedale San Bortolo-Vicenza, Vicenza 36100, Italy
| | - Arturo Rebeccato
- Dipartimento di Chirurgia, AULSS8 Berica-Ospedale San Bortolo-Vicenza, Vicenza 36100, Italy
| | - Michele Novi
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Fabio Catani
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto, University of Modena and Reggio Emilia, Modena 41121, Italy
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Abstract
INTRODUCTION Paediatric ankle fractures represents about 5% of all paediatric fractures. It is the most common physis to be injured in the lower limb accounting to approximately 15-20% of all physeal injuries. This article reviews the literature on this common injury which still has many controversial areas and gives guidelines to management based on the existing evidence along with clinical experience gained from a Level I trauma center. CLASSIFICATION The original Salter-Harris Classification with the additional types is a good system to guide on the management. The transitional fractures form a separate group with technically two broad types-biplane and triplane injuries. Though there are many sub-types in this group with some popular eponymous fractures, the treatment principles remain the same. MANAGEMENT A very low threshold for CT scan is recommended when there is a clinical suspicion of fracture with a negative radiograph or an intra-articular fracture in the radiograph especially in the adolescent age group. CT scan helps in accurate quantification of the intra-articular displacement and also helps to comprehend the fracture geometry better. All the intra-articular fractures with displacement > 2 mm need perfect anatomical reduction and stabilization. Assisted closed reduction and percutaneous fixation along with arthrogram to confirm articular congruity is acceptable as long as the reduction is perfect. Irrespective of the method of treatment, in children with more than 2 years of growth remaining it is important to counsel regarding the high incidence of pre-mature physeal closure and the need for regular follow-up.
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[Ankle fractures in children and adolescents]. Unfallchirurg 2020; 123:731-739. [PMID: 32785731 DOI: 10.1007/s00113-020-00855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In children and adolescents, injuries of the ankle are seen frequently in routine practice. The fracture pattern is less dependent on the mechanism of injury than on the maturity of the growth plate. Therefore, a differentiation is made between fractures with open epiphyses and fractures with a closing growth plate in adolescents. The potential for growth-related spontaneous deformity correction is limited, so axial alignment especially in the frontal plane has to be achieved during initial treatment. In displaced articular fractures an anatomical reconstruction of the articular surface and stable osteosynthesis have to be achieved to minimize the risk of early osteoarthritis. Growth arrest is not always avoidable despite an ideal reconstruction and can occur in all fracture types; however, with optimal conservative or surgical treatment, iatrogenic damage of the epiphysis can be avoided thereby reducing the incidence of growth disorders as a complication of ankle fractures in children and growing adolescents.
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Rauer T, Pape HC, Gamble JG, Vitale N, Halvachizadeh S, Allemann F. Transitional fracture of the distal radius: a rare injury in adolescent athletes. Case series and literature review. Eur J Med Res 2020; 25:21. [PMID: 32517738 PMCID: PMC7285726 DOI: 10.1186/s40001-020-00419-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/04/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Transitional fractures are fractures in adolescents where partial closure of the epiphyseal growth plate has occurred. These fractures are most commonly reported in the distal tibia. With respect to the distal radius, only a few case reports describing transitional fractures exist. Furthermore, relatively little is known about epiphyseal closure of the distal radius. A case series of four transitional fractures of the distal radius is presented by comparing non-operative and operative treatment options. At present, this is the largest case series in the literature dealing with this rare injury. CASE PRESENTATION We present three cases of four transitional fractures of the distal radius including 1-year follow-up. Patient age ranged from 16 to 18 years including a gender ratio of two males to one female. Clinical and radiographic assessments took place 6 and 12 weeks and 1 year after trauma/surgery. Three transitional fractures were treated with open reduction and internal volar plate fixation followed by functional rehabilitation. One transitional fracture was treated non-operatively. All cases showed an excellent functional outcome. CONCLUSIONS The primary treatment goal in transitional fractures is anatomic reduction of the articular surface. Non-operative treatment of transitional fractures of the distal radius is the most commonly reported treatment option. Additionally, different fixation options have been described, including the use of Kirschner wires (K-wires) and lag screws. The presented cases demonstrate that volar plate fixation followed by functional rehabilitation is a valuable treatment option in significantly displaced transitional fractures of the distal radius. Furthermore, we discuss the pathogenesis as well as the different treatment options by critical reviewing the literature.
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Affiliation(s)
- Thomas Rauer
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Hans-Christoph Pape
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | - Nicolo' Vitale
- Physical Medicine and Rehabilitation, Department of Biomedicine and Biotechnology, University of Catania, Catania, Italy
| | - Sascha Halvachizadeh
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Florin Allemann
- Division of Trauma Surgery, UniversityHospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Abstract
Ankle injuries are a common reason for presentation to the pediatric emergency department. An understanding of the anatomy of the ankle joint, the mechanism of injury, and a thorough history and physical examination can help narrow the differential diagnosis. This article will discuss the management of common ankle injuries, including ankle sprains, dislocations, and pediatric fractures, including transitional triplane and Tillaux fractures. A brief review of the literature regarding radiographic evaluation of the ankle and various ankle rules is also discussed.
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Rammelt S, Boszczyk A. Computed Tomography in the Diagnosis and Treatment of Ankle Fractures: A Critical Analysis Review. JBJS Rev 2019; 6:e7. [PMID: 30562210 DOI: 10.2106/jbjs.rvw.17.00209] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Stefan Rammelt
- University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Andrzej Boszczyk
- Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Prof. Adam Gruca Clinical Hospital, Otwock, Poland
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Voth M, Kremer L, Marzi I. [Fractures of the lower extremities in childhood : Part 2: lower leg and ankle fractures]. Chirurg 2018; 88:983-994. [PMID: 29026917 DOI: 10.1007/s00104-017-0515-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The treatment of pediatric patients in trauma surgery is a special situation in every aspect. For deciding on the correct treatment of fractures of the lower leg and ankle joint, various parameters, such as residual growth rate, skeletal age and height of the patient are decisive. The differences between fractures in children and adolescents are the open epiphyseal plate and the resulting residual growth. The bones of young children have a higher healing tendency and a greater potential for correction than in adolescents. Especially in the lower leg and the ankle joint, the potential for correction is decisive for the healing of fractures and for possible development of growth disorders. The limits of tolerance concerning axial malalignments and the expected spontaneous potential for correction must play an essential role for further treatment with conservative or operative therapy. This article deals with the special features of pediatric fractures of the lower leg and ankle joint.
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Affiliation(s)
- M Voth
- Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - L Kremer
- Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - I Marzi
- Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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12
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Hadad MJ, Sullivan BT, Sponseller PD. Surgically Relevant Patterns in Triplane Fractures: A Mapping Study. J Bone Joint Surg Am 2018; 100:1039-1046. [PMID: 29916931 DOI: 10.2106/jbjs.17.01279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Triplane ankle fractures are complex transitional fractures that often necessitate surgical treatment. Axial fracture lines determine optimal screw trajectories for fixation. The purpose of our study was to identify fracture patterns in triplane fractures by illustrating fracture lines in the axial plane of the distal tibial metaphysis and epiphysis. METHODS We retrospectively reviewed records of children presenting with ankle fractures at 1 center from January 2007 through June 2017. Thirty-three cases of triplane fractures with available computed tomographic (CT) scans were identified. Fractures in the axial plane of the metaphysis were identified 10 mm proximal to the physis, and fractures in the epiphysis were identified midway between the physis and distal tibial articular surface. Fracture lines were drawn and were superimposed on unfractured bone templates to generate fracture maps, and heat maps were then created to show areas of high and low fracture densities. RESULTS In the metaphysis, the most common fracture pattern was medial-lateral lines in the posterior metaphysis. This metaphyseal pattern was consistent across 2, 3, 4, and 5-part fractures. There were clear zones of rare fracture involvement in the anterior and anterolateral metaphysis. In the epiphysis, anterior-to-posterior fracture lines were common in the anterior epiphysis. All cases had an epiphyseal fracture exit through the anterior epiphysis. Fracture extension into the posteromedial epiphysis was a feature of all fracture classes. CONCLUSIONS Fracture mapping of triplane fractures suggests consistent axial fracture patterns in the metaphysis and epiphysis with additional class-dependent fractures in the epiphysis. This study provides visual guidelines to assist surgeons in understanding the axial fracture patterns of individual triplane fractures for surgical planning.
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Affiliation(s)
- Matthew J Hadad
- Division of Pediatric Orthopaedics, Department of Orthopaedics, The Johns Hopkins University, Baltimore, Maryland
| | - Brian T Sullivan
- Division of Pediatric Orthopaedics, Department of Orthopaedics, The Johns Hopkins University, Baltimore, Maryland
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Schneidmueller D, von Rüden C, Friederichs J, Bühren V. [Transitional fractures : Epiphyseal injuries in adolescence]. Unfallchirurg 2017; 119:517-26. [PMID: 27240851 DOI: 10.1007/s00113-016-0186-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The so-called transitional fractures describe articular fractures in adolescents with partial closure of the epiphyseal growth plate. This shows a specific stereotype fracture pattern, which can be differentiated into biplane, triplane I and triplane II fractures depending on the involvement of the metaphysis and the number of fragments. The diagnostics and therapy can differ from fractures where the epiphyseal growth plate is still open. The main focus for surgical treatment is the reconstruction of the articular surface whereas relevant growth disturbances no longer need to be feared when the epiphysis has already begun to close.
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Affiliation(s)
- D Schneidmueller
- Abteilung für Unfallchirurgie, Sportorthopädie und Kindertraumatologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland. .,BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland.
| | - C von Rüden
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.,BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - J Friederichs
- Abteilung für Unfallchirurgie, Sportorthopädie und Kindertraumatologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland.,BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - V Bühren
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
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