Tri-Plane Ankle Fracture – Salter Harris Fracture – Fixed with Ankle Arthroscopy Guidance

12 yo female fell roller skating. She presented to ED which noted distal tibial Salter Harris fracture…. Is this a true Salter Harris injury? The plain film images are deceivingly simple. She was placed in a CAM boot by the ED, and referred for definitive care.

We ordered CT to further evaluate extent of growth plate injury. After reviewing CT with family we decided to proceed with arthroscopic guided ORIF. The displacement at epiphysis measured ~5mm at biggest
gap. We used all percutaneous fixation to reduce, and closed incisions with monocryl.

We felt using the 1.9mm Nanoscope allowed us to visualize the chondral surface as atraumatically as possible, while still lending to acceptable reduction. Using this smaller sized scope has been a wonderful tool especially in pediatric cases.

Our post reduction measurements at the anterior chondral surface of the plafond measured <1mm. You’ll note in 1 of the videos us dragging the scope from P to A showing the post-reduction fissure in the plafond that is left. There is also a pre and post reduction still Nano image – side by side.

We did a lot of debridement pre and post reduction to remove debris ( extruded hematoma, chondral debris, synovitis) which we felt would help substantially with post-ORIF arthrosis.

Seeing the joint surfaces without making larger open incisions seems like a good approach. Literature on Triplane fractures supports this, seemingly. It was interesting to see how much more impressively violated the chondral surface was via intra-articular visualization.

Note: 3rd video shows us actively tightening screws.

Patient is doing excellent thus far, and starting physical therapy.