The complex triplane fracture: Ipsilateral tibial shaft and distal triplane fracture

Background. The complex triplane fracture (ipsilateral tibial shaft and distal tibial triplane fracture) is a rare combination. It has not previously been described in the literature. This combination can be easily overlooked and has the potential for serious sequelae if it is missed. Methods Six patients, having sustained this combined injury, were reviewed at a tertiary children's hospital. Clinical assessment, radiographs, computed tomographic scans, bone age, and scanogram assessment of leg length at maturity were completed. Results. Average age at injury was 14 years. Tibial fractures were midshaft or short oblique. There were 3 three-part and 3 two-part intra-articular distal tibial triplane fractures. Diagnosis of the distal triplane fracture was delayed in two cases. Treatment involved application of a long leg cast. No patients required open reduction. At follow-up (average, 22 months), all patients were asymptomatic. All fractures were well healed and there was no evidence of joint incongruity, or angular or rotational deformity. Leg length discrepancy averaged 6.8 mm. Conclusion. A high index of suspicion should be maintained to avoid missing this rare combination, as it has the potential for long-term sequelae.