My 14 year old son fractured his Tibia while skateboarding when we were on vacation 3 days ago. He was put in a temporary cast and told to follow up with an Orthopedic Surgeon within 5 days. This is the report we were given to take to the Surgeon...There is an obliquely oriented fracture through the tibial metaphysis that extends into the physis. A suspected component is seen extending into the anteromedial aspect of the epiphysis as there is a subtle lucency running into this plane. There is an ankle joint effusion.
Can someone better explain this to me in non doctors langue!!
Does anyone know if this type of fracture would require surgery?
I'll be glad to help you with the terminology. You might want to get a picture of the tibia and ankle of the joint. It would help if you get one that shows a skeletally immature bone, with the growth plates shown:
"There is an obliquely oriented fracture through the tibial metaphysis that extends into the physis."
>> The fracture line goes obliquely through the metaphysis. The metaphysis is the flare portion of the distal tibia, as it goes from the straight shaft portion into the broad portion that makes up the ankle joint.
..The physis is the growth plate. The physis goes straight across the distal tibia, about 2 cm above the plafond. The plafond is the top part of the ankle joint, or the bottom of the tibia that goes straight across. The fracture line touches (involves) the physis. The physis is a weak spot in the bone, since it is made up of cartilage.
"A suspected component is seen extending into the anteromedial aspect of the epiphysis as there is a subtle lucency running into this plane."
>> The physician thinks that the fracture line goes across the epiphysis. The epiphysis is the portion of the bone from the physis to the end of the bone.
"There is an ankle joint effusion"
>> An effusion is swelling within the joint capsule.
This is most likely a Triplane fracture of the distal tibia. Called a Triplane fracture because it is in three different planes (oblique, horizontal, vertical).
A Triplane fracture only occurs in adolescents. It requires the physis to be at the stage where it is starting to close, part of the physis has already fused. The adolescent may still grow in height for a few more years, but this signals that the growth plates are starting to fuse and the bones are becoming skeletally mature.
So, the fracture goes at an angle across the flare (metaphysis) of the distal tibia, into the growth plate (physis) going horizontally a little, then down across the end of the bone (epiphysis), into the joint.
Though the physician states that the fracture line across the epiphysis is suspected, the fact that there is an effusion makes it pretty likely. Any time a fracture extends into a joint, there is an effusion. Broken bones bleed a lot, so when the fracture is into the joint, the blood collects inside the joint capsule, thus producing an effusion.
As to whether this is going to need surgery, depends upon how much the fragments are displaced, especially at the joint surface and physis.
It is very important to reduce the fracture within the joint, so that the surface is smooth, without any step-offs. If the fracture is not reduced, the chances of traumatic arthritis go way up.
In terms of the physis, anytime a fracture involves the physis, there can be disturbances in growth at that growth plate. In the case of a Triplane fracture, the physis is already closing, so it may not make a big difference, but in general, you do not want to manipulate the physis a lot during reduction and you want to try to get the physis reduced (put back in place) as well as possible.
So, again, depending upon how much the fracture is displaced, these can be treated with either casting or surgery.
It is important to see an orthopedic surgeon as soon as you can, so just in case surgery is needed, it can be done in a prompt manner.
If there is something that I did not explain quite well enough, do not hesitate to ask further questions. Again, if you can Google a picture of a tibia with the growth plates shown, it is a lot easier to understand. And don't feel bad, it takes orthopedic residents a little while to understand the anatomy of a Triplane fracture.
Hope your son feels better soon. How is the numbness in the toes doing? With this injury it is going to be very important to keep the foot really up in the air, above the heart level (really above the head), to keep the swelling to a minimum. If he does need surgery, the swelling should be as minimal as possible. Surgery occasionally has to be delayed because of swelling. Also, massive swelling can cause what are called fracture blisters. And again, if he needs surgery, sometimes if there are fracture blisters, the surgery can't be done till the blisters have healed.
Also, make sure he wriggles his toes. With this fracture pattern, the tendons that cross the ankle joint tend to scarred down very easily. By moving the toes, the tendons are kept gliding, so the chances of scarring are decreased. It should not be all that uncomfortable to move the toes. The first few times are going to be the most uncomfortable, but the more they are moved, the easier it becomes. If it is really extrememly painful to move the toes, that is concerning and the surgeon should be contacted. On very rare cases, when it is extremely painful to move the toes after a fracture, it can be a sign of a compartment syndrome, which is a surgical emergency. Again, this is only if it is really extremely painful.