Case Reports
Intramalleolar Triplane Fracture With Osteochondral Talar Defect
Am J Orthop. 2008 May;37(5):262-266
Author and Disclosure Information
Wendy L. Heusch, DO, and Henry W. Albers, MD
Dr Heusch is Orthopedic Surgeon, Rainer Orthopedic Institute, Puyallup, Washington. She was Orthopedic Resident, Grandview Hospital and Medical Center, Dayton, Ohio, at the time the article was written.
Dr. Albers is Director of Orthopedics, Children's Medical Center, Dayton, Ohio, and Associate Clinical Professor, Wright State University, Dayton, Ohio.
Abstract not available. Introduction provided instead.
Triplane fracture of the ankle is an uncommon injury that presents in adolescents after partial closure of the distal tibial physis. Ehalt1 and Titze,2 in the 1960s, first described triplane fractures as “transitional fractures” of the distal tibia. Marmor,3 in 1970, described a fracture of the distal tibia as consisting of 3 separate fracture fragments—a free anterolateral epiphyseal fragment, a posterior metaphyseal fragment (including the remainder of the epiphysis), and the tibial shaft. Lynn4
then introduced the term triplane fracture to describe this fracture in 1972. In 1978, Cooperman and colleagues5 reported that a 2-fragment configuration was more common than a 3-fragment configuration and emphasized the importance of obtaining a computed tomography (CT) scan to evaluate these fractures.
Von Laer,6 who also emphasized the importance of CT scans for evaluating complex triplane fractures, described 2 types of intramalleolar triplane fractures—one extending outside the weight-bearing surface and the other extending into the tibial plafond at the junction of the medial malleolus.
Feldman and colleagues7 and O’Connor and Mulligan8 described case reports of extra-articular, intramalleolar triplane fractures. These intramalleolar fractures were treated nonoperatively (with acceptable results) because of the extra-articular fracture pattern. Shin and colleagues,9 in 1997, proposed 3 types of intramalleolar triplane fractures: I (intra-articular, within the weight-bearing zone), II (intra-articular, outside the weight-bearing zone), and III (extra-articular).
Osteochondral fractures of the talus are more common than triplane fractures. Osteochondral lesions are injuries to the dome of the talus where the cartilaginous
fragments separate from the talar dome with or without the subchondral bone. Many terms, including talar dome lesion, osteochondritis dissecans, transchondral fracture, and osteochondral defect, have been used to describe these lesions.10
In reviewing the literature, we found several reports of direct correlations between talar dome lesions and ankle injuries and fractures but did not find any reports of
osteochondral lesions of the talus occurring with a triplane fracture of the distal tibia in adolescents. Sorrento and Mlodzienski11 found that 38% of supination–external rotation stage IV fractures of the ankle were associated with lateral talar dome lesions (mean age, 44 years). Ferkel and Orwin12 similarly reported that, of 288 ankle fractures, 79% had articular lesions.
In this article, we report the case of a 14-year-old boy who sustained an intramalleolar triplane fracture with an osteochondral defect of the talus and then present the results of our literature review.