A TILLAUX FRACTURE IS A TRAUMATIC SALTER–HARRIS TYPE III

 

A Tillaux fracture is a traumatic Salter–Harris type III fracture through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement.

It accounts for 3-5% of pediatric ankle fractures and more commonly seen in girls. Tillaux feacture is seen in children nearing skeletal maturity (12-14 years old), when the medial epiphysis had closed but before the lateral side has done so.

The fracture commonly results from an abduction-external rotation force, causing the anterior tibiofibular ligament to avulse the anterolateral corner of the distal tibial epiphysis, at the opposite end to a Wagstaffe-Le Fort avulsion fracture, resulting in a Salter Harris Type III fracture.

Variability in fracture pattern is due to progression of physeal closure as anterolateral part of distal tibial physis is the last to close. When the lateral physis is the only portion not fused, external rotation may lead to Tillaux or Triplane fractures. Lack of coronal plane fracture in the posterior distal tibial metaphysis distinguishes this fracture from a triplane fracture.

Associated conditions commonly seen with this fracture are distal fibular fracture (usually SH I or II) and ipsilateral tibial shaft fracture.

If the displacement at fracture is less than 2 mm, it may be managed conservatively. However, displacement requires open reduction and internal fixation, especially when displacement is over 2 mm.

As with any intra-articular fracture if a step is left in the articular surface, then the joint will go on to premature secondary osteoarthritis.
This fracture pattern is named after Paul Jules Tillaux, a French Anatomist and Surgeon (1834-1904).

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2019-11-22 11:41
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