Tillaux fracture (P. Tillaux (1834-1904): French physician.)
First described by Sir Astley Cooper (1822), Paul Tillaux further delineated the mechanism of this injury as an avulsion fracture caused by the pull of the anteroinferior tibiofibular ligament secondary to external rotation of the foot and ankle in the ankle mortise.
Occurs in adolescents around time of fusion of distal tibial physis. Physis fuses initially centrally then medially then laterally. The anterior tibio fibular ligament avulses piece of epiphysis resulting in a Salter-Harris type-III fracture of the anterolateral portion of the distal tibia.
Radiology
Like Triplane fractures the true extent of injury may not be appreciated on plane radiographs.
CT is the imaging study of choice in evaluating displacement of the juvenile Tillaux fracture.
In a study comparing CT to plain radiographs it was found CT was very sensitive in identifying fractures with > 2mm displacement but seemed to overstate the amount of fracture displacement.
Treatment
Growth disturbance is not much of an issue as the physis is in the process of closing more importantly is joint surface congruity.
Reduce with internal rotation and supination.
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<2 mm of displacement - treat conservatively (Above knee cast 4 wks, then below knee 2wks)
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2 to 5 mm of displacement but no articular step-off - gray zone between open and closed treatment. (see expectations). If large fragment err on reducing and fixing
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>5mm displacement - try closed reduction initially, open and reduce if after closed reduction residual displacement > 2mm.
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Once reduced fix percutaneously or open.
References
Horn, B. David; Crisci, Kristin; Krug, Matthew; Pizzutillo, Peter D; MacEwen, G. Dean; Radiologic Evaluation of Juvenile Tillaux Fractures of the Distal Tibia. Journal of Pediatric Orthopedics. 21(2):162-164, March/April 2001
FLYNN, JOHN M. SKAGGS, DAVID. SPONSELLER, PAUL D. GANLEY, THEODORE J. KAY, ROBERT M. LEITCH, K. KELLIE MD. The operative management of paediatric fractures of the lower extremity. J BJS - A; Vol. 84-A(12):2288-2300, December 2002.
Tillaux P. Recherches cliniques et experimentales sur les fractures malleolaires. Rapport par Gosselin. Bull Acad Med, Paris, Ser. 1872;21:817