Aims Paediatric triplane fractures and adult trimalleolar ankle fractures both arise from a supination external rotation injury. By relating the experience of adult to paediatric fractures, clarification has been sought on the sequence of injury, ligament involvement, and fracture pattern of triplane fractures. This study explores the similarities between triplane and trimalleolar fractures for each stage of the Lauge-Hansen classification, with the aim of aiding reduction and fixation techniques. Methods Imaging data of 83 paediatric patients with triplane fractures and 100 adult patients with trimalleolar fractures were collected, and their fracture morphology was compared using fracture maps. Visual fracture maps were assessed, classified, and compared with each other, to establish the progression of injury according to the Lauge-Hansen classification. Results Four stages of injury in triplane fractures, resembling the adult supination external rotation Lauge-Hansen stages, were observed. Stage I consists of rupture of the anterior syndesmosis or small avulsion of the anterolateral tibia in trimalleolar fractures, and the avulsion of a larger Tillaux fragment in triplanes. Stage II is defined as oblique fracturing of the fibula at the level of the syndesmosis, present in all trimalleolar fractures and in 30% (25/83) of triplane fractures. Stage III is the fracturing of the posterior malleolus. In trimalleolar fractures, the different Haraguchi types can be discerned. In triplane fractures, the delineation of the posterior fragment has a wave-like shape, which is part of the characteristic Y-pattern of triplane fractures, originating from the Tillaux fragment. Stage IV represents a fracture of the medial malleolus, which is highly variable in both the trimalleolar and triplane fractures. Conclusion The paediatric triplane and adult trimalleolar fractures share common features according to the Lauge-Hansen classification. This highlights that the adolescent injury arises from a combination of ligament traction and a growth plate in the process of closing. With this knowledge, a specific sequence of reduction and optimal screw positions are recommended.

中文翻译：

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了解儿童三平面踝关节骨折与成人三踝骨折的损伤机制和骨折模式。


目的 儿童三平面骨折和成人三踝踝关节骨折均由旋后外旋损伤引起。通过将成人与儿童骨折的经验联系起来，我们对三平面骨折的损伤顺序、韧带受累和骨折模式进行了澄清。本研究探讨了 Lauge-Hansen 分类各阶段三平面骨折和三踝骨折之间的相似性，旨在帮助复位和固定技术。方法收集83例儿童三平面骨折患者和100例成人三踝骨折患者的影像学资料，利用骨折图比较骨折形态。对视觉骨折图进行评估、分类并相互比较，以根据 Lauge-Hansen 分类确定损伤的进展情况。结果观察到三平面骨折损伤的四个阶段，类似于成人旋后外旋Lauge-Hansen阶段。 I 期包括前韧带联合破裂或三踝骨折中胫骨前外侧的小撕脱，以及三平面中较大 Tillaux 碎片的撕脱。 II 期被定义为腓骨在韧带联合水平的倾斜骨折，存在于所有三踝骨折和 30% (25/83) 的三平面骨折中。第三阶段是后踝骨折。在三踝骨折中，可以辨别不同的 Haraguchi 类型。在三平面骨折中，后骨折块的轮廓呈波浪状，是源自 Tillaux 骨折的三平面骨折特征 Y 型的一部分。 IV 期代表内踝骨折，在三踝骨折和三平面骨折中变化很大。结论 根据 Lauge-Hansen 分类，儿童三平面骨折和成人三踝骨折具有共同特征。这凸显出青少年损伤是由韧带牵引和生长板闭合过程中的共同作用引起的。有了这些知识，就可以推荐特定的复位顺序和最佳螺钉位置。