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Functional Outcome Analysis of Triplane and Tillaux Fractures After Closed Reduction and Percutaneous Fixation

Choudhry, Imran K. MD*; Wall, Eric J. MD; Eismann, Emily A. MS; Crawford, Alvin H. MD; Wilson, Lindsay BA

Journal of Pediatric Orthopaedics: March 2014 - Volume 34 - Issue 2 - p 139–143
doi: 10.1097/BPO.0000000000000085
Trauma

Background: There are limited data regarding the outcomes of triplane and tillaux fractures. The purpose of our study was to provide a long-term follow-up analysis of the functional outcomes as they relate to articular displacement using validated outcome tools.

Methods: A retrospective chart and radiographic review was performed to identify the age, the sex, the treatment method, complications, the fracture type, and articular displacement. Most patients underwent closed reduction with percutaneous fixation. We used 2 validated outcome measures, namely the Foot and Ankle Outcomes Score and the Marx Activity Scale, to assess functional results at a minimum of 2 years from the time of injury.

Results: We identified 78 patients between 2000 and 2009 who underwent computed tomographic scan evaluation of either a triplane (n=58) or a tillaux fracture (n=20). Triplane fractures occurred at a significantly younger age than tillaux fractures for both men and women (P=0.01). Women were found to suffer transitional fractures at a younger age than men (P<0.001). Patients with residual articular displacement of up to 2.4 mm after definitive treatment did not have worse functional outcomes compared with those who had an anatomic reduction on any of the Foot and Ankle Outcomes Score subscales and the Marx Activity Scale. Similarly, there was no correlation between the magnitude of residual gap or step-off with functional outcome when the gap and step-off are <2.5 mm. Patients with longer-term follow-up (>4 y) did not have deterioration of function compared with those with a follow-up of 2 to 4 years.

Conclusions: Tillaux and triplane fractures have good medium-term outcomes after reduction and fixation. Using primarily closed reduction and percutaneous fixation techniques, patients with a residual displacement of <2.5 mm after treatment have a uniformly good result. Functional results do not deteriorate at longer-term follow-up (4 to 10 y) as long as adequate reduction has been achieved. Percutaneous fixation yielded uniformly good results on all scales.

Level of Evidence: Therapeutic level III.

*Department of Orthopaedics, University of Cincinnati

Department of Orthopaedics, Cincinnati Children’s Medical Center, Cincinnati, OH

The authors declare no conflict of interest.

Reprints: Eric J. Wall, MD, Department of Orthopaedic Surgery, Cincinnati Children’s Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH 45229-3039. E-mail: eric.wall@cchmc.org.

© 2014 by Lippincott Williams & Wilkins