A 22-year-old sports player sustains a tri-plane fracture of the distal tibia. This fracture is unique to a specific age group because it occurs during:

• A Complete physeal closure in adults, creating a predictable fracture pattern through sclerotic bone
• B Osteoporotic trabecular loss causing multi-plane insufficiency fractures in the elderly
• C Growth plate growth acceleration in early puberty creating zones of weakness in two planes
• D Asymmetric closure of the distal tibial physis in adolescents, producing a fracture with components in all three planes ✓

Explanation

The triplane fracture is a transitional fracture occurring in adolescents (ages 12–15) during asymmetric physeal closure of the distal tibia. The physis closes centrally first, then anterolaterally, then posteriorly. This asymmetric closure creates areas of differential strength, so external rotation forces produce a fracture with components simultaneously in the sagittal plane (through epiphysis), axial plane (through physis), and coronal plane (through metaphysis) — giving three fracture planes (tri-plane). CT is essential for characterisation. Displacement >2 mm requires surgical reduction.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.