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Question
13 year-old female with ankle pain following fall down escalator. What's the diagnosis?
Answer
Answer: Tri-plane ankle fracture
Tri-plane Fractures
- Multi-planar ankle fracture in older children and adolescents during an 18 month window prior to distal tibial-physis closure.
- 3 planes (see Xray below): coronal (A: tibal metaphysis), sagital (B: epiphysis), and transverse (C: growth plate)
- Associated fibular spiral fracture (50% cases)
- Commonly due to external rotational or "twisting" forces.
- Xrays are helpfully, but CT scan may be indicated as fractures may be more displaced than radiographs suggest.
- Non-operative treatment for non-displaced fractures:
- Closed reduction with long-leg splint/cast
- Reduction may slip once swelling has subsided
- Indications for operative repair:
- >2mm displacement of fracture segments
- Intra-articular fracture
References
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