Computed Tomography of Intraarticular Supination - Eversion Fractures of the Ankle in Adolescents

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Abstract
Intraarticular fractures of the ankle in children known as the Tillaux and triplane fractures of the distal tibia are caused by supination-eversion. To determine the 3-dimensional configuration of these fractures and the relation of the fracture to the growth plate and the joint, computed tomography (CT) was performed in 1 case with Tillaux fracture and in four cases with triplane fracture, besides conventional radiography and tomography. The Tillaux fracture showed 2 fragments. The triplane fracture consisted of 2-4 fragments representing 3 types of fracture, depending on type of investigation. Conventional radiographs could not differ between 2 and 3 fragment triplane fractures, whereas CT offered possibilities to register the epiphyseal and metaphyseal fractures in detail and the exact displacement of the fracture. In 1 case with a 3 fragment fracture diagnosed by conventional tomography and CT, a 4 fragment fracture was revealed at operation. This patient had a fracture through the anteromedial part of the growth plate without displacement. According to this and previous investigations, the Tillaux and triplane fractures represent at least 5 different anatomical patterns of intraarticular supination eversion injuries.

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