Triplane fractures of the adolescent ankle commonly require operative management. A number of classification systems exist showing a variety of fracture patterns, making fixation planning complex. Our institute has previously presented a classification system that simplifies the fracture pattern. Our aim was to find a fixation method that could be used in all cases. We devised a universal screw trajectory for the epiphyseal fracture based on a partially threaded screw placed medial-to-lateral at 20 degrees to the inter-malleolar axis of the ankle. We retrospectively reviewed the axial CT images of 59 consecutive operatively managed triplane fractures from a single institute to simulate the placement of the screw. In all 59 subjects, the simulated universal screw placement was in a satisfactory position to adequately, and safely, reduce the fracture. Two cases were classified as ‘Tillaux variants’, which are classically managed with a lateral-to-medial screw, but they were deemed to be potentially suitable for the universal screw, indeed in one case the treating surgeon used a medial-to-lateral screw and had a successful outcome. Our classification system demonstrates a reproducible fracture line that is amenable to a universal screw fixation method in the world's largest published triplane series. It offers a low-tech solution to a difficult problem. This could simplify the preoperative plan and obviate the need for a CT scan, which is relevant to departments treating populations without access to such resources

Introduction

In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated.