eMedicine Specialties > Orthopedic Surgery > Trauma

Triplane Fracture: Workup

Author: John L Abt, DO, FACEP, FACFE, Clinical Associate Professor and Senior Consulting Staff, Department of Emergency Medicine, Mount Sinai Medical Center of Miami
Coauthor(s): Vinod K Panchbhavi, MD, FRCS, FACS, Associate Professor, Chief, Division of Foot and Ankle Surgery, Department of Orthopedics, University of Texas Medical Branch School of Medicine
Contributor Information and Disclosures

Updated: Jun 12, 2009

Workup

Laboratory Studies

  • Laboratory studies performed depend on the age of the patient, the extent of all injuries, and other comorbid conditions. Triplane fractures most commonly occur in healthy adolescents. CBC, sequential multiple analysis (SMA7), urinalysis, and blood type and screen are reasonable, but not mandatory, preoperative studies.

Imaging Studies

  • Plain film radiography of the ankle (distal tibia, fibula, and talus): If the patient demonstrates localized pain, inability to fully bear weight, ankle deformity, confounding variables (eg, patient age <18 y), underlying neurologic deficits affecting the lower limbs, altered mental status, and/or multisystem trauma, or if the patient otherwise meets the Ottawa rules indicating that radiologic evaluation should be performed, obtain anteroposterior (AP), lateral, and ankle mortise views with the foot in 15° of internal rotation.
    • The saddle or headset sign should be observed. The saddle (or telephone headset), consisting of the tibia and fibula, should lie congruently above and around the talus (the horse or the telephone base).
    • The space between the talar dome and a curved line running along the internal surfaces of the distal tibia and fibula (ankle mortise space) should be equal throughout its length. Lack of symmetry suggests ankle mortise disruption due to ligamentous injury or bony fracture.
  • Plain film radiography of the foot
    • Indications for radiologic studies of the foot include localized pain, deformity, or the inability to bear weight completely.
    • Obtain AP and lateral foot films.
    • Direct attention to areas at high-risk for associated injuries (eg, proximal fifth metatarsal, navicular, cuboid, medial cuneiform, calcaneal bones).
  • Plain film radiography of the fibula and tibia
    • Triplane and other ankle fractures are frequently associated with fibula fractures. As a result, forces are transmitted to the fibula in a lateral, medial, or spiral (twisting) motion.
    • Spiral stresses, in particular, may result in a Maisonneuve fracture of the proximal fibula. These are easily missed if the knee and proximal fibula are not examined at the time the ankle and foot are examined.
    • If pain or tenderness is present anywhere along the length of the fibula, x-ray the fibula. This applies equally to any area of the tibia not apparently associated with the primary area of injury.
  • Other x-rays performed in anticipation of the operating room depend on the age of the patient, the extent of all injuries, and other comorbid conditions. Triplane fractures most commonly occur in healthy adolescents. Chest x-ray is a reasonable, but not mandatory, preoperative study.
  • CT scan
    • CT scanning is not indicated for routine evaluation of common ankle fractures; but it is required to assess complex multipart and/or multiplane fractures of the ankle.32
    • CT scanning demonstrates fracture lines, fracture segments, and intra-articular extent and enables the accurate measurement of displacement. If surgery is being contemplated, it helps with planning the surgical incisions and the direction and orientation of implants such as screws for internal fixation.
  • Stress radiographs: These images may be obtained when plain film evaluation reveals no obvious fractures. Preferably, these radiographs are obtained following orthopedic consultation, as stress films lend little to the management of ankle injuries by emergency department physicians.

More on Triplane Fracture

Overview: Triplane Fracture
Workup: Triplane Fracture
Treatment: Triplane Fracture
Follow-up: Triplane Fracture
Multimedia: Triplane Fracture
References
Further Reading
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Keywords

triplane fracture, transitional fracture, ankle fracture, Marmor-Lynn fracture, multiplane fracture, multipart fracture, adolescent tibial triplane fracture, tibial fracture, tibia fracture, tibial epiphysis, tibial growth plate, growth plate, epiphyseal fracture, epiphyseal growth plate, physis, physeal fracture, distal tibia, distal tibial epiphysis, distal tibial metaphysis, tibia, Maisonneuve fibular fracture, distal fibula, proximal fibula, fibula fracture, fibular fracture

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Contributor Information and Disclosures

Author

John L Abt, DO, FACEP, FACFE, Clinical Associate Professor and Senior Consulting Staff, Department of Emergency Medicine, Mount Sinai Medical Center of Miami
John L Abt, DO, FACEP, FACFE is a member of the following medical societies: American College of Emergency Physicians, American College of Forensic Examiners, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Vinod K Panchbhavi, MD, FRCS, FACS, Associate Professor, Chief, Division of Foot and Ankle Surgery, Department of Orthopedics, University of Texas Medical Branch School of Medicine
Vinod K Panchbhavi, MD, FRCS, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Foot and Ankle Society, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

John S Early, MD, Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship Baylor University Medical Center
John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association
Disclosure: Zimmer Inc Consulting fee Consulting; Smith Nephew Consulting fee Consulting; AO North America Honoraria Speaking and teaching; Osteotech Consulting fee Consulting; Stryker Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FAAOS, Chairman, J Vernon Luck Distinguished Professor, Department of Orthopedic Surgery, University of Missouri
Jason H Calhoun, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

 
 
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