Imaging description

A 12-year-old female presented with a history of injury to the left ankle. An AP radiograph of the left ankle demonstrated a fracture in the distal lateral metaphysis of the left tibia with associated widening at the lateral aspect of the physis and probable epiphyseal fracture also, suggesting a Salter–Harris type IV fracture (Fig. 89.1a). The lateral radiograph more clearly demonstrated an extension of the fracture into the epiphysis (Fig. 89.1b), suggesting a complex triplane Salter–Harris type IV fracture with the epiphysis fractured in the sagittal plane, the physis separated in the axial plane, and the metaphysis fractured in the coronal plane. A CT scan better demonstrated the extent of the fracture with an anterolateral bony fragment of the tibial epiphysis and intra-articular extension into the tibiofibular syndesmosis and tibiotalar joint (Fig. 89.1c). Coronal and sagittal CT reformats clearly demonstrated the fractures of the posterolateral metaphysis, anterolateral physis, and central epiphysis (Fig. 89.1d–f) with involvement of the tibial plafond. The intra-articular extension into the tibiotalar joint was characterized by wide separation of the epiphyseal fragments at the joint surface with a displaced anterolateral epiphyseal fragment. The medial malleolus was intact.