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What is a triplane fracture of the ankle? My brother just texted me that this is what his son (my nephew) has that requires an operation. I'm going to notify my church prayer chain but thought I would get some details first.

Triplane fractures of the ankle affect three sections of the lower part of the tibia (lower leg bone). That's why they are called "triplane." The force of injury is strong enough to split the joint surface, fracture the epiphysis (round end of the tibia), move through the growth plate, and go out the metaphysis (area between the main part of the bone and the epiphysis at the end of the bone). The growth plate is contained within the metaphysis. The location and severity of triplane fractures cannot be fully assessed from plain X-rays. CT scans must be taken in order to show the fracture line through multiple planes and angles of the tibia. Different fracture lines will be seen when viewed from the front/back (coronal view), side (sagittal view), and above (axial or transverse view). This is what is meant by a fracture that is triplanar. A major complication in treating triplanar ankle fractures is the gap or step-off that can occur if the bones shift. When this happens, the bones no longer line up, which means the two sides of the ankle joint is no longer evenly matched. Such a situation has to be treated or the uneven weight-bearing surface will be painful. Down the road, arthritis will develop causing further problems. These fractures can be treated with closed reduction (without an incision) if the patient makes it to the surgeon within the first 72 hours. General anesthesia is still used to put the patient to sleep when this is done. Open surgery is only required when efforts to traction and place the bones in correct position fail. Any of these fractures that are not stable will need some type of fixation (metal plate, screws, pins, wires). The surgeon will have many decisions to make from what tests to order, whether surgery is needed, what type of surgery, and specific techniques to use for these complex and challenging types of injuries. In the meantime, your nephew may be experiencing pain or discomfort, fear about the treatment, and there is always the need to pray there are no complications with the injury, the surgery, and during the recovery.

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