Arthroscopically assisted surgical fixation of a juvenile Tillaux fracture and implant removal: A case report.

Abstract

Juvenile Tillaux fractures are Salter-Hallis III fractures of the distal tibial epiphysis that occur only when the tibial epiphyses are closing. Theoretically, arthroscopically assisted reduction and fixation of a juvenile Tillaux fracture can facilitate the accurate reconstruction of the articular surface, using arthroscopic visualization. We treated a girl aged 14 years who had a juvenile Tillaux fracture by using arthroscopically assisted reduction and fixation. In order to obtain articular congruency, the screw was inserted under arthroscopic visualization. Although the screw was placed through the epiphysis, the patient had no symptoms of discomfort and the functional results were excellent. We performed a second operation to remove the implant 9 months later. During this procedure, arthroscopy indicated the healing of the fracture site and an intact articular surface. At the 1.5year follow-up, the radiograph indicated that the epiphysis was closed normally and that the patient had no symptoms. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 100, or excellent. Although screw insertion into the epiphysis should be avoided, reconstructing the congruency of the joint surface is of higher priority in repairing the epiphysis.