Tough day: Triplane fracture

Case presentation

A 12-year-old male presents to the emergency department with left ankle pain. Two hours ago, he was jumping on a trampoline when he “landed wrong, twisting” the ankle. He cannot remember in which direction the ankle twisted but he states he developed swelling to the ankle and had difficulty ambulating due to pain. He denies neck pain, back pain, numbness, and weakness, and there is no other injury. His examination reveals a pleasant patient with vital signs that are appropriate for his age. There is swelling and tenderness to the left lateral malleolus. He has diminished range of motion secondary to pain and does not want to bear weight. He has good dorsalis pedis and posterior tibial pulses with brisk capillary refill. He is neurologically intact. The rest of the extremity has no signs of injury.

Imaging considerations