1: J Bone Joint Surg Am  1985 Jun;67(5):687-98 

Classification, diagnosis, and treatment of transitional fractures of the distal
part of the tibia.

von Laer L.

I studied the anatomical relationships in thirty-two transitional fractures of
the distal part of the tibia by standard radiography and in thirteen of these
patients by computerized axial tomography. Three different configurations of
fractures could be identified: biplane fractures and two different types of
triplane fractures (Type I and Type II). In the biplane lesion the fracture is
restricted to the epiphysis, while the triplane fractures are characterized by a
wedge of metaphyseal bone. In the Type-I triplane lesion the metaphyseal portion
of the fracture ends in the physis, while in the Type-II triplane lesion the
metaphyseal portion of the fracture line extends through the physis into the
epiphysis and the joint. On the anteroposterior radiograph, the epiphyseal
fracture line in both the biplane and the two types of triplane fractures may be
found anywhere from the extreme medial to the extreme lateral position. Its
location, however, is exclusively dependent on the maturity of the distal tibial
physis and is not influenced by the mechanism of injury. The use of computerized
axial tomography has revealed the true dimensions of these fractures, and the
diagnosis of biplane and triplane fractures can now be made by standard
radiography alone. However, the evaluation of undisplaced or only slightly
displaced Type-II triplane fractures will still occasionally require the use of
computerized axial tomography. Displaced transitional fractures with a fracture
gap of more than two millimeters in the weight-bearing portion of the epiphysis
require open reduction. If the gap is less than two millimeters, non-operative
treatment with a plaster cast is sufficient.

PMID: 3997921 [PubMed - indexed for MEDLINE]