Narrative review of the pediatric triplane ankle fracture — a transitional injury caused by asymmetric distal tibial physeal closure that cannot be classified within the Salter-Harris system. Covers pathophysiology, fracture variants, diagnostic imaging, and treatment selection based on displacement and articular involvement.
When an adolescent presents with an ankle injury that looks like SH III on AP and SH II on lateral, get a CT — you're looking at a triplane fracture, and plain films will underestimate displacement and fragment number every time.
The management hinge is displacement: cast for <2 mm, attempt closed reduction for 2–3 mm, and go straight to ORIF for >3 mm because closed reduction will fail and long-term arthrosis follows any residual step-off beyond 2 mm.
Narrative review of the pediatric triplane ankle fracture — a transitional injury caused by asymmetric distal tibial physeal closure that cannot be classified within the Salter-Harris system. Covers pathophysiology, fracture variants, diagnostic imaging, and treatment selection based on displacement and articular involvement.
When an adolescent presents with an ankle injury that looks like SH III on AP and SH II on lateral, get a CT — you're looking at a triplane fracture, and plain films will underestimate displacement and fragment number every time.
The management hinge is displacement: cast for <2 mm, attempt closed reduction for 2–3 mm, and go straight to ORIF for >3 mm because closed reduction will fail and long-term arthrosis follows any residual step-off beyond 2 mm.