A Hotouras, N Sandiford, M Enchill-Yawson
ankle injuries, tibial epiphysis, tillaux fracture
A Hotouras, N Sandiford, M Enchill-Yawson. Isolated Juvenile Tillaux Fracture: A Case Report. The Internet Journal of Orthopedic Surgery. 2006 Volume 5 Number 2.
Tillaux fractures are relatively uncommon Salter- Harris type III fractures involving avulsion of the anterolateral tibial epiphysis. We present the case of a 16 year old boy who sustained and isolated Tillaux fracture and discuss it management.
A 16 year old boy attended the Accident and Emergency department with an injury to his right foot. He sustained the injury while wrestling, after his opponent landed on his right foot. A “crack” was heard and he was unable to weight bear. On examination there was mild swelling around the ankle joint and tenderness over the lateral malleolus. The skin was intact and there was no neurovascular deficit. Radiographic images of his right foot are shown below
A diagnosis of Tillaux fracture was made and the patient was scheduled to undergo open reduction and internal fixation. Following an anterolateral incision, the fragment was identified, reduced and fixed with a fully threaded 45mm cancellous screw
Tillaux fractures are uncommon Salter Harris type III fractures of the anterolateral part of the tibial epiphysis. They usually occur in children between 12 and 15 years of age, after the middle and medial parts of the epiphyseal plate have closed but before the lateral part closes.1 The mechanism of injury involves external rotation and extension of the foot leading to avulsion of this physeal fragment due to excessive tension of the tibio-fibular ligament.2
Tillaux Fractures may be managed conservatively with closed reduction (i.e. internal rotation of the ankle and foot supination) but any element of displacement should not be acceptable.3 Fractures associated with displacement > 2mm with rotation of the fragment should be managed operatively.4