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Self-Assessment Questions

Orthopaedic Surgery

Answer 2
  1. Open reduction and screw fixation. Preoperative CT scans are useful in planning surgical management of triplane fractures. Fractures with gapping or articular displacement of more than 2 mm require operative fixation.1 In this case, closed reduction and casting is inadequate based on the extent of fracture displacement. The use of locking plates in osteosynthesis of a triplane fracture may result in growth disturbance and requires more hardware than necessary for stable fixation. Placement of an external fixator would not allow for anatomic reduction of the articular surface and is not recommended. Surgical reduction is performed via an anterolateral or anteromedial approach depending on the fracture fragment orientation. The typical order of treatment for triplane fractures is: (1) address the anterolateral fracture, (2) reduce the posteromedial fracture with dorsiflexion and inversion of the foot, (3) reduce and fix the fibula if a fracture is present, and (4) secure the anterolateral fragment. Initially reducing the posteromedial fragment is thought to be crucial to fixation of triplane fractures. Regardless of the pattern of reduction, anatomic alignment of the articular surface is essential to the long-term success of treatment, and screws are sufficient for rigid internal fixation of fracture fragments.

     Schnetzler KA, Hoernschemeyer D. The pediatric triplane ankle fracture. J Am Acad Orthop Surg 2007;15:738–47.

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