Abstract

The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are transitioning to skeletal maturity. Owing to its rarity, the optimal management strategy for this fracture is not well-described. The aim of this review was to assess the outcomes of operatively and nonoperatively managed displaced adolescent Tillaux fractures. We analysed articles from The Cochrane Library, PubMed, MEDLINE, and EMBASE databases that met our predetermined inclusion and exclusion criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. A descriptive data analysis was performed. A total of 461 articles were identified from the data search, of which 13 articles were included for full-text analysis. Five of these studies reported recognised patient outcome measures and the remaining eight reported on radiographic follow-up. The reported studies included a total of 114 patients with Tillaux fractures; 58.8% of patients were female and 34.2% were male. Mean ages ranged from 12.5 to 15 years, with the youngest patient being 12 years old and the oldest 17 years old. Overall mean follow-up was 42.8 months. Of the patients, 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically. The remainder were treated nonoperatively. Outcome measures were excellent for all patients irrespective of operative management choice. Follow-up radiographic deformity was only evident in Tillaux fractures that were managed nonoperatively; deformity included poor joint congruity, angular deformity, and tibial shortening. These nonoperative patients have a residual fracture displacement of 2 mm. There were no reported instances of premature physeal closure for any patient. This review shows that excellent patient outcomes have been reported for different methods of operative fixation, however, study sizes are small and data is sparse. Further robust comparative studies are required to identify definitive conclusions. The use of established clinical and radiographic outcome measures will help improve the quality of future studies for this relatively rare injury.

Highlights

  • BackgroundSir Astley Cooper first described a fracture of the lateral tibial plafond in 1822 [1]

  • The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis

  • 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically

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Summary

Introduction

BackgroundSir Astley Cooper first described a fracture of the lateral tibial plafond in 1822 [1]. Paul Jule Tillaux defined an experimental mechanism for the occurrence of this fracture in 1876, in which the pull of the anterior inferior tibiofibular ligament caused an avulsion fracture of the distal tibia in adult cadavers [2]. The Chaput tubercle can be seen as the insertion site of the anterior inferior tibiofibular ligament at the anterolateral aspect of the distal tibia. The lesion is most commonly referred to as a Tillaux fracture and occasionally as a Tillaux-Chaput fracture. The initial description of this injury was in adults, with occurrence in the adolescent population being referred to as the juvenile Tillaux fracture. In 1964, Kleiger and Mankin were the first to report on a series of adolescent patients with this injury [4]

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