# Tri-plane ankle fracture



## coderguy1939 (Nov 2, 2009)

From what I can determine, this is a Salter-Harris type IV fracture in three planes-sagittal-epiphysis, transverse-physis and coronal-metaphysis.

The doctor is calling this a closed reduction with internal fixation.

The note reads:

A very small nick is performed, being careful to protect the lateral cutaneous nerve structures of the foot, making this just through the skin only and then spreading.  Then the AO reduction clamp is applied with skin nick also medially.  It is applied at an angle, compressing the anterior portion of the fracture where the primary displacement was and also slightly wiggling the fracture so it could set underneath the anterolateral physeal plate appropriately.  Once reduction had been obtained and confirmed in multiple planes, it is held with the reduction clamp.  Then a small nick, again only through the skin and then spreading through the subcutaneous, is made over the apex of the fracture, again at the angle per plans drawn from the CT scan.  A guide pin is then placed and over-drilled with the appropriate cannulated drill.  Then the screw is placed.  It is a 36mm length screw with ample length so the screw threads will be beyond the fracture line.  A small washer is the applied to it.  The screw is fully seated and checked.  The clamp is then removed and reduction appears to be anatomic based on multiple views with the mini C-arm.

This sounds like an open procedure to me.  I'd appreciate some input on this one.  Thanks.

I'm looking at 27827.


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## kjstearns (Nov 2, 2009)

I agree, sounds like an open procedure to me!


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## mbort (Nov 4, 2009)

almost sounds like a perc pinning to me--I would query the surgeon.


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