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KMID : 0386420240370010001
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Journal of the Korean Fracture Society
2024 Volume.37 No. 1 p.1 ~ p.7
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Triplane Fracture Management: Prediction of Periosteal Entrapment and the Need for Open Reduction by Measurements of the Physeal Fracture Gap in Preoperative Computed Tomography Scans
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Lee Dae-Hee
Kwon Joo-Han
Jung Jae-Uk
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Abstract
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Purpose: This study measured the physeal fracture gap on preoperative ankle computed tomography (CT) to predict the periosteal entrapment that requires an open reduction in distal tibia triplane fractures.
Materials and Methods: This study retrospectively reviewed patients who had undergone internal fixation for a triplane fracture from April 2004 to September 2022. The demographic data, including age, body mass index, and past medical history, were analyzed. In the radiographic evaluations, ankle CT and ankle simple radiographs, including anteroposterior (AP), lateral, and mortise views, were taken preoperatively. Postoperatively, simple ankle radiographs were obtained periodically, including AP, mortise, and lateral views. The physeal fracture gap was measured on ankle CT, and the larger gap between the coronal and sagittal view of CT was selected. The residual physeal gap <2 mm was considered an adequate reduction.
Results: Of 17 cases, three demonstrated successful reduction using closed reduction techniques. Periosteal entrapment was observed in 14 cases open reduction cases. In all three closed reduction cases, the physeal gap estimated on preoperative ankle CT was under 3 mm with a mean gap of 2.4±0.2 mm (range, 2.1-2.5 mm). In the remaining 14 open reduction cases, the measured physeal gap was over 3 mm, averaging 5.0±2.7 mm (range, 3.1-12.2 mm). There was a significant difference in the preoperative physeal gap between the two groups (p<0.01). Overall, good reduction was achieved in all 17 cases; the postoperative physeal gap was under 2 mm with a mean of 1.0±0.5 mm (closed reduction group, 0.5±0.2 mm; open reduction group, 1.1±0.5 mm).
Conclusion: Open reduction is strongly recommended for triplane fractures with a physeal fracture gap of 3 mm or more in preoperative ankle CT, suggesting the possibility of an entrapped periosteum in the fracture gap.
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KEYWORD
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Tibial fracture, Pediatric, Growth plate, Periosteum, Entrapment
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