Asisstance Arthroscopy in Juvenile Tillaux Fractures

Abstract

Introduction:Juvenile Tillaux Fracture is an isolated fracture of the lateral portion of the distal tibial epiphysis, considered SALTER-HARRIS fracture type 3, wherein the fragment is moved by the anterolateral ligament anterior inferior tibiofibular. They occur at the beginning of the 2nd decade of life and are caused by a force external rotation. The pattern of injury is considered a result of the closing sequence of the distal tibial physis, which usually closes around 15 years of age in girls and 17 in boys, this process usually takes about 18 months, occurring first in the central area of the physis, extending medially and finally to side, being this epiphyseal portion which is open at the time of the vulnerable to fracture injury in this age group. The curriculum includes RX, and TAC, being more sensitive to detect fragments of 2 or more mm of travel, but may overestimate the true displacement. The non-displaced fracture can be treated with cast immobilization and displaced with closed reduction (plantar flexion external rotation in the pronated foot and direct pressure on the anterolateral epiphysis). An equal displacement or > 2 mm of the articular surface is indication of open reduction and percutaneous fixation, because it may increase the risk of osteoarthritis in the future.Objective:Presentation of a case Juvenile Tillaux Fractures with surgical resolution under arthroscopic assistance.Methods:Male patient 14 years old who suffered indirect trauma left ankle during practice sports (rugby) in September 2015, 48 hours of evolution. After performing X-rays and scans one left Salter Harris type III at the level of distal tibial epiphysis (Tillaux fracture) ankle fracture was diagnosed. It had a greater than 2 mm displacement. As a reduction treatment and percutaneous osteosynthesis with more osteodesis screw with arthroscopic assistance and fluoroscopy was performed. After surgery a long leg cast was placed for three weeks, continuing with three other short boot. By the third week the plug removal. After the sixth week began with partial load with Walker boot for a month and later full charge.Results:Fracture healing was evident in the eighth week. Now in his eighth postoperative month and has an excellent performance according to the AOFAS score of 96 points, with no pain, full range of motion and return to sport after 4th month.Discussion:There are reports such as A. Kaya et.al (2007) with excellent results (AOFAS 99.3) in a series of 10 patients treated by open reduction and internal fixation and in other hand A. Panagopoulus, L.van Kiekerk (2007) reports excellent results (AOFAS 100) in patients treated under arthroscopic assistance. Assistance arthroscopy in Tillaux fractures allows a reduction more accurate than that provided by percutaneous techniques fluoroscopy guided only by avoiding the problems associated with open techniques (lesion of the superficial peroneal nerve and necrosis of the fragment). It also allows patients to an early return to activities with a lower risk of stiffness and secondary osteoarthritis due to the reduction achieved under direct arthroscopic visualization.