Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Bone Joint J. 2024 Sep 1;106-B(9):1008-1014. doi: 10.1302/0301-620X.106B9.BJJ-2024-0120.R1.
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.
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.
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.
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.
小儿三踝骨折和成人三踝骨折均源于旋后外旋损伤。通过将成人骨折的经验与小儿骨折相联系，已经阐明了三踝骨折的损伤顺序、韧带受累和骨折类型。本研究探讨了 Lauge-Hansen 分类各阶段三踝骨折和三踝骨折之间的相似性，旨在帮助复位和固定技术。
收集了 83 例小儿三踝骨折和 100 例成人三踝骨折患者的影像学资料，并使用骨折图比较其骨折形态。通过视觉骨折图评估、分类和相互比较，根据 Lauge-Hansen 分类确定损伤的进展。
观察到小儿三踝骨折有四个损伤阶段，类似于成人旋后外旋 Lauge-Hansen 阶段。第 I 阶段包括前联合破裂或前外侧胫骨小撕脱，在三踝骨折中为较大的Tillaux 碎片撕脱；第 II 阶段定义为联合水平腓骨斜形骨折，在所有三踝骨折中均存在，在 30%（25/83）的三踝骨折中存在；第 III 阶段是后踝骨折。在三踝骨折中，可以辨别不同的 Haraguchi 类型。在三踝骨折中，后骨折块的描绘呈波浪状，这是三踝骨折特征性 Y 形的一部分，源自 Tillaux 碎片。第 IV 阶段代表内踝骨折，在三踝骨折和三踝骨折中均高度可变。
根据 Lauge-Hansen 分类，小儿三踝骨折和成人三踝骨折具有共同特征。这表明青少年损伤是由韧带牵引和生长板在闭合过程中的组合引起的。有了这些知识，建议采用特定的复位顺序和最佳螺钉位置。
