Triplane Fracture Clinical Presentation

Updated: Apr 23, 2020
  • Author: John L Abt, DO, FACEP, FACFE; Chief Editor: Jeffrey D Thomson, MD  more...
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An accurate account recreating the action that led to the injury assists the practitioner in predicting the area of injury. In a triplane fracture of the ankle, nearly all cases involve an external rotation of the foot on the tibia, creating stress along the distal lateral open tibial growth plate. Other contributing forces that propagate the fracture lines are axial loading in combination with the foot being in plantar flexion (most common) and supination, abduction, or pronation.

Patients are more likely to be adolescent males with right-side ankle injuries.

Inquire about other areas of injury or pain. The pain of a triplane fracture is sufficient to distract attention from other areas, even when a significant injury is present.

Document other chronic medical conditions (eg, prior injury or surgery; orthopedic hardware in the area of injury; diabetes; peripheral vascular disease; metabolic bone disease).

Determine current and recent medication use, including corticosteroids.


Physical Examination

Patients with a triplane fracture of the ankle present with the following:

  • Pain
  • Swelling
  • Possible ecchymosis
  • Possible ankle deformity
  • Inability to bear weight on the injured ankle

Observe all areas for evidence of open injury, including lacerations and abrasions. Ask the patient to demonstrate any ankle and toe motion that can be performed voluntarily without assistance.

Check for posterior tibial and dorsalis pedis pulses, and compare these with the pulses on the uninjured side. Note that up to 15% of the population has a congenital absence of the dorsalis pedis artery. Check for adequate distal capillary artery refill—that is, 2 seconds or less.

Check for distal sensation and evidence of compartment syndrome tingling, decreased sensation, swelling, pale skin, diminished pulses, and severe pain with passive movement of the toes.

Examine the knee, the leg, and the foot for tenderness, ecchymosis, and swelling. Radiographs of the knee, the leg, and the foot are needed if there are positive findings. Pay careful attention to the fibula, which must also be palpated and inspected along its entire length. Fibular fractures are commonly associated with triplane fractures. A fibular fracture likely to be missed upon initial evaluation is the Maisonneuve fracture of the proximal fibula, as reported by Healy. [31]

Inspect and palpate other areas at high risk for fracture, such as the calcaneus and the proximal fifth metatarsal. Cup the calcaneus as if it were a tennis ball, and gently compress it. If pain is elicited, be highly suspicious of a calcaneal fracture.