Tillaux fracture

Background

• Salter-Harris type III fracture of the anterolateral portion of the distal tibia
  • caused by an avulsion of anterior inferior tibiofibular ligament
• Occurs typically in adolescents, age 12-14
  • occurs in children nearing skeletal maturity, as anterolateral portion most vulnerable at this age

Clinical Features

• Typically due to external rotation force
  • forced lateral rotation of foot OR medial rotation of leg on a fixed foot
• Often associated with external rotation deformity of the ankle/foot

Differential Diagnosis

Distal Leg Fractures

• Tibial plateau fracture
• Tibial shaft fracture
• Pilon fracture
• Maisonneuve fracture
• Tibia fracture (peds)
• Ankle fracture
  • Ankle fracture (peds)
    • Tillaux fracture
• Foot and toe fractures

Evaluation

• XR
  • Salter-Harris III fx of anterolateral distal tibia epiphysis
• CT scan
  • further delineates fracture pattern and degree of displacement

Management

• Ortho consult
• Nonoperative
  • closed reduction, long leg cast x 4wks, short leg cast x 2-3wks
  • indicated only if <2mm of displacement after closed reduction (rare)
• Operative
  • Open reduction and internal fixation (ORIF)
  • indicated if >2mm of displacement after reduction attempt

Disposition

• Most will require surgical reduction
• Admit

See Also

• Salter-Harris fractures

References

• Tintinalli 7th Edition, pg 905
• http://radiopaedia.org/articles/tillaux-fracture
• http://orthobullets.com/pediatrics/4028/tillaux-fractures

Authors

Kaoru Itakura, Ross Donaldson