title: Triplane fractures: do we need cross-sectional imaging?
abstract: BACKGROUND
  Diagnosis of Triplane fractures remains difficult in common practice. Aim of the study was the evaluation of the fracture pattern and the benefit of cross-sectional imaging in classification of Triplane-fractures.
  
  
  METHODS
  A total of 27 pediatric patients treated for ankle fractures were identified from patient charts. Radiographic images of epiphyseal fractures (X-rays and additional cross-sectional imaging) were blinded evaluated by 13 observers to answer a specific questionnaire regarding type or fracture and treatment suggestion.
  
  
  RESULTS
  There were seven Triplane-I and eight Triplane-II fractures. The other physeal ankle fracture group consisted of four patients with a Twoplane-fracture, five Salter-and-Harris (SH) II, one SH-III, and two SH-IV fracture. Accuracy of classification improved considerably depending on the experience of the observer in pediatric trauma care. Surgeons specialized in pediatric trauma care classified correctly with conventional X-rays in 48.1 % of all cases presented versus 31.5 % appropriate diagnosis by younger fellows. Accuracy in exact specification of Triplane-fractures was comparable lesser in younger fellows (31.1 vs. 22 %). Cross-sectional imaging improved classification of all fractures in both groups (75.6 % specialized vs. 47.3 % non specialized). Whereas availability of cross-sectional imaging improved treatment recommendation in specialized surgeons this benefit was not detectable for the doctors without specialization. Evaluation of fracture pattern showed a relatively stereotypical fracture pattern in Triplane-II fractures, whereas Triplane-I fractures were more variable.
  
  
  CONCLUSIONS
  The additional information of cross-sectional imaging seems helpful for any physician in finding the right classification of a pediatric ankle fracture. However, the additive information appears especially viable for experienced surgeons to suggest the appropriate treatment.
authors.affiliation: Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany. dorien.schneidmueller@bgu-murnau.de.|Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany. dorien.schneidmueller@bgu-murnau.de.
authors.forename: D
authors.initials: D
authors.lastname: Schneidmueller
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: A L
authors.initials: AL
authors.lastname: Sander
authors.affiliation: Department of Surgery, Diaconessenhuis, Meppel, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Wertenbroek
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Wutzler
authors.affiliation: Department of Trauma, Orthopaedic, Spine and Pediatric Trauma Surgery, Asklepios Klinik Lich, Lich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kraus
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Marzi
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Laurer
keywords: Ankle joint; Distal tibia fracture; Physeal fracture; Pre-operative imaging; Transitional fracture; Triplane
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