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
Evaluation
- XR
- Salter-Harris III fracture of anterolateral distal tibia epiphysis
- CT scan
- further delineates fracture pattern and degree of displacement
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Ortho consult
Disposition
- Most will require surgical reduction
- Admit
Specialty Care
- 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
See Also
External Links
References
- Tintinalli 7th Edition, pg 905
- http://radiopaedia.org/articles/tillaux-fracture
- http://orthobullets.com/pediatrics/4028/tillaux-fractures
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