Triplane fracture in a 12-year-old boy

Frontal (A) and lateral (B) radiographs of the right ankle demonstrating a triplane fracture. The frontal view demonstrates faint visualization of the epiphyseal fracture (arrow) along the sagittal plane and the superior edge of the metaphyseal fracture in the coronal plane (arrowhead). The lateral view demonstrates the widening along the anterior margin of the physis (asterisk), a sagittal epiphyseal fracture (arrowhead), and posterior metaphyseal fracture extension (arrow). Oblique fracture across the distal fibular shaft is noted in both frontal and lateral views (curved arrow). CT scans of the right ankle demonstrating in better detail the morphologic complexity of the triplane fracture. Axial image at the level of the distal tibial epiphysis (C) and axial image at the level of the distal tibial physis (D) showing epiphyseal widening and displacement in the sagittal plane (arrow) with irregularity and multiple fracture fragments at the physis (curved arrow). Sagittal reformation (E) demonstrating both physeal (arrow) and posterior metaphyseal (curved arrow) fracture extension of a Salter-Harris type II fracture, in addition to a cortical fracture fragment (arrowhead) interposed along the posterior metaphyseal cortical fracture fragments, which could potentially interfere with surgical reduction. Three dimensionally shaded surface reformation (F) showing anterolateral displacement of the epiphysis and physeal fracture extension of a Salter-Harris type III fracture of the tibia (arrow), in addition to a distal fibular oblique fracture (arrowhead).