A: Triplanar ankle fractures occur in children between the ages of 10 and 16. Boys are affected more often between 13 to 15 years and girls between 12 and 14 years. The difference has to do with when the growth plates close (sooner in girls than boys).

Triplanar refers to three directions or orientations of fracture. These include the sagittal (front-to-back) plane, transverse (side-to-side) plane, and frontal (top-to-bottom) plane.

The location and degree of damage depends in part on the status of the growth plates. Since these growth areas don't close all at the same time, some areas are at greater risk for fracture than others.

Treatment is determined based on two things: fracture reduction and joint incongruity. Reduction refers to how well the bones can be matched back up to their normal alignment. Surgery is usually needed to pull the bones back down into place.

If this can be done without an open incision by using traction, then it is referred to as a closed reduction. This procedure is done under general anesthesia. Then the patient is put in a long leg cast while the ankle heals.

If the fracture remains displaced by more than three millimeters, then the surgeon will likely use an open reduction. The standard procedure involves making as many incisions as needed to correct the alignment. Metal plates, screws, wires, and/or pins are used to hold everything in place once the bone fragments are realigned as close to normal as possible.

More recently, surgeons have started using arthroscopic surgery. The scope allows the surgeon to see inside the joint. This makes it possible to get better alignment and fixation. Surgical trauma is less with this method. Direct visualization allows for more accurate joint congruity.

Reference: Kent A. Schnetzler, MD, MS, and Daniel Hoernschemeyer, MD. The Pediatric Triplane Ankle Fracture. In Journal of the American Academy of Orthopaedic Surgeons. December 2007. Vol. 15. No. 12. Pp. 738-747.