The triplane fracture: four years of follow-up of 21 cases and review of the literature.

The triplane fracture of the distal tibia consists of several anatomic types, including two to four principal fracture fragments. According to previous calculations, 7% of all ankle fractures in girls and 15% in boys birth to 18 years old who have open growth plates are triplane fractures. In this update of a previous study and literature review of 209 cases (108 boys and 101 girls), the mean ages in boys and girls were 14.8 and 12.8 years, respectively (P < 0.00005). The triplane fracture did not occur in children younger than 10 and not in those older than 16.7 years. Thirty-five percent of the cases were treated without reduction, 30% with closed reduction, and 35% with open reduction. The choice of treatment depended on many variations in the materials reviewed. Excellent results were reported in 79% of 184 cases with follow-up. Neither age, sex, stage, nor treatment had a consistent influence on the frequency of less-than-excellent results. There was a weak tendency to deteriorating results with time to follow-up (r = 0.19, P = 0.016). Inadequate reduction seemed to be an important factor in the few cases with fair or poor results (4.7%), even if this presumption could not be verified statistically.