ULTRASOUND MODIFIERS AS A DIAGNOSTIC CONCEPTION FOR TRIPLANE AND TILLAUX FRACTURES IN CHILDREN

Backgraund: The greatest challenge in diagnosis and selection of the optimal treatment method are Tillaux and triplane fractures. Computed tomography cannot to be a screening test for ankle injuries due to the high radiation exposure and limited availability on an outpatient basis. Sonographic examination is a safely method, does not require patient transportation, and allows damage in real time. Non-invasive methods are use to study regional blood supply.
Aims: Ultrasonic modifiers to developed for Tillaux and triplane fractures of the distal tibia in children with assessment of microcirculatory activity in the area of injury in the postoperative period.
Materials and methods: We performed a prospective, open-label study of patients aged 11 to 14 years with triplane and Tillaux fractures. The total number of patients is 70 people. Ultrasound examination of the ankle joint was performed in all patients. The mechanism of injury was assessed according to the Lauge-Hansen classification. laser Doppler flowmetry method was used over a period of 4 to 6 weeks. The rate of the regenerative process was assessed in 20 patients.
Results: These populations had criteria of homogeneity with little variation. The following ultrasonic damage modifiers were identified: isolated two-part triplane fracture with an intact or partially damaged anterior part of the distal tibiofibular syndesmosis, isolated Tillaux fracture with an intact or damaged anterior part of the distal tibiofibular syndesmosis, three- and four-part triplane fracture with partial damage or rupture of the anterior part of the distal tibiofibular syndesmosis, Tillaux fracture with an ipsilateral fracture of the fibula, complicated by a partial or complete rupture of the distal tibiofibular syndesmosis, a triplane fracture with an ipsilateral fracture of the fibula, complicated by a partial or complete rupture of the distal tibiofibular syndesmosis.
Conclusions: The known classification characteristics of typical fractures are supplemented by damage to soft tissue structures. The laser Doppler flowmetry method made it possible to assess the microcirculatory activity of the injury in the postoperative period.

1. Pomeranz CB, Bartolotta RJ. Pediatric ankle injuries: utilizing the Dias-Tachdjian classification. Skeletal Radiology. 2019; 49(4): 521-30. doi: 10.1007/s00256-019-03356-0.

2. Yuan Q, Guo Z, Wang X. Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome. J Orthop Surg Res. 2020; 15(1): 423. doi: 10.1186/s13018-020-01961-7.

3. Angoules AG. Triplane Fracture: An Intricate Pediatric Injury. Emergency Med. 2016; 6(1): 142. doi: 10.4172/2165-7548.1000e142.

4. Kathleen DR, Edmonds EW. What’s New in Pediatric Orthopaedic Trauma: The Lower Extremity. J Pediatr Orthop. 2018; 38(8): 434-39. doi: 10.1097/BPO.0000000000001209.

5. Binkley A, Charles TM, Ellen F. Salter-Harris II ankle fractures in children: does fracture pattern matter? J. Orthop Trauma. 2019; 33(5): 190-5. doi: 10.1097/BOT.0000000000001422.

6. Milz P, Milz S, Steinborn M, et al. Lateral ankle ligaments and tibiofibular syndesmosis. 13-MHz high-frequency sonography and MRI compared in 20 patients. Acta Orthop Scand. 1998; 69(1): 51-5. doi: 10.3109/ 17453679809002357.

7. Wasik J, Stoltny T, Leksowska-Pawliczek M, еt al. Ankle Osteoarthritis – Arthroplasty or Arthrodesis? Ortop Traumatol Rehabil. 2018; 20(5): 361-37. doi: 10.5604/01.3001.0012.7282.

8. Agafonova AA, Krupatkin AI, Dorokhin AI. Clinical and pathogenetic significance of the microvascular component of bone tissue. N.N. Priorov Journal of Traumatology and Orthopedics. 2023; 30(3): 357-66. (In Russ.) doi: 10.17816/vto466576.

9. Chaturvedi A, Mann L, Cain U, et al. Acute Fractures and Dislocations of the Ankle and Foot in Children. Radiographics. 2020; 40(3): 754-74. doi: 10.1148/rg.2020190154.

10. Kramer DE, Cleary MX, Miller PE, et al. Syndesmosis injuries in the pediatric and adolescent athlete. J Child Orthop. 2017; 11(1): 57-63. doi: 10.1302/1863-2548.11.160180.