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Tillaux Fractures

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Topic updated on 06/28/15 5:36pm
Introduction
  • Salter-Harris III fx of the distal tibia epiphysis
    • caused by an avulsion of the anterior inferior tibiofibular ligament  
  • Mechanism
    • mechanism of injury is thought to be due to an external rotation force
  • Epidemiology
    • typically occurs between age 12 to 14
  • Pathoanatomy
    • lack of fracture in the posterior distal tibial metaphysis in the coronal plane distinguishes this fracture from a triplane injury
    • occurs in older children at the end of growth
      • variability in fracture pattern due to progression of physeal closure
      • a period of time exists when the lateral physis is the only portion not fused
      • leads to Tillaux and Triplane fractures
      • often associated with external rotation deformity of the ankle/foot
Anatomy
  • Ossification
    • the distal tibial physis closes in the following order
      • central (first)
      • posterior
      • medial
      • anterolateral (last)
Imaging 
  • Radiographs
    • SH III fx of the anterolateral distal tibia epiphysis 
  • CT scan  
    • delineate the fracture pattern  
    • determine degree of displacement
    • identify intramalleolar or medial fracture variant patterns
Treatment
  • Nonoperative
    • closed reduction, long leg cast for 4 weeks, SLC x 2-3 weeks
      • indications
        •  if  < 2 mm of displacement (rare) following closed reduction
      • technique
        • reduction technique by internally rotating foot
        • CT scans sometimes needed to determine residual displacement (confirm < 2mm) 
        • long leg cast needed initially due to rotational component of injury
  • Operative
    • open reduction and internal fixation 
      • indications
        • if  >2 mm of displacement remains after reduction attempt
      • technique
        • closed reduction can be attempted under general anesthesia first
          • percutaneous screws can be placed if adequate reduction obtained
        • visualize the joint line to optimize reduction
        • screws placed with attempt to remain intra-epiphyseal
        • arthroscopically assisted reduction has been described
Complications
  • Premature growth arrest
    • rare 
      • little physis remaining as closure is already occuring
    • decrease risk with anatomic reduction
  • Early arthritis
    • increase risk with articular displacement

 

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Qbank (2 Questions)

TAG
(OBQ12.223) A 12-year-old sustains a twisting injury to his ankle while playing soccer. His skin is intact and he has no evidence of neurovascular compromise. An injury radiograph is shown in Figure A. A closed reduction is attempted to improve alignment. What is the next best step after reduction to optimize this patient’s outcome? Topic Review Topic
FIGURES: A          

1. Splinting and admit for observation for compartment syndrome
2. Short leg cast and discharge with outpatient follow up
3. Long leg cast and discharge with outpatient follow up
4. Percutaneous pinning with casting immobilization
5. CT scan of the ankle

PREFERRED RESPONSE ▶
TAG
(OBQ08.102) A juvenile Tillaux ankle fracture is caused by an avulsion injury involving which of the following structures? Topic Review Topic

1. Anterior-inferior tibiofibular ligament
2. Posterior-inferior tibiofibular ligament
3. Anterior talofibular ligament
4. Posterior talofibular ligament
5. Calcaneofibular ligament

PREFERRED RESPONSE ▶




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