Recognition and management of Tillaux fractures in adolescents

Tillaux fractures are relatively uncommon Salter Harris III fractures of th e tibia, The importance of recognizing this fracture is that a residual def ormity in the joint surface can lead to premature degenerative arthritis. F or this reason, it is important that accurate imaging to assess the congrui ty of the joint, as well as adequate reduction, is obtained. These fracture s can occur in adolescents in the 18-month period during which the distal t ibial epiphysis is closing. These injuries occur either by lateral rotation of the foot or by medial rotation of the leg on the fixed foot. Closed red uction is sufficient in most cases; however, if a gap of greater than or eq ual to 2 mm of the articular surface remains, open reduction is usually req uired to adequately reduce the articular surface. Orthopedic injuries are one of the most common reasons children are brought to the emergency department (ED), Most of these injuries are easily manage d by splinting, with outpatient orthopedic follow-up. However, certain frac tures need closer evaluation and immediate consultation with an orthopedic surgeon. One relatively uncommon fracture that needs special attention is t he Tillaux fracture. Paul Jules Tillaux first described this particular fracture in 1892, He per formed experiments on cadavers and found that stress to the anterior inferi or tibiofibular ligament could lead to this type of avulsion fracture, whic h today is termed the Tillaux fracture (1), The distal tibial epiphysis is involved, and the mechanism usually is forced external rotation of the foot in a 12- to 14-year-old adolescent. This fracture only occurs during a cer tain time of adolescence, owing to the differential growth rate of the epip hysis, and only under certain circumstances (2, 3). The fracture is of grea t importance because it involves a major weight-bearing articular surface. A residual deformity of the joint surface can lead to premature degenerativ e arthritis (4). We present a patient with a Tillaux fracture to elaborate on the mechanism of injury and to summarize the importance of its recognition and imaging an d treatment options.