Abstract
Adolescents are at risk of unique ankle fracture patterns due to closing physes. Transitional ankle fractures, in particular, are an entity specific to adolescent patients due to the asymmetrically open distal tibia physis. Transitional ankle fractures are rarely seen in combination with bimalleolar ankle fracture patterns. This case is of interest because the combined fracture pattern and the treatment method presented have not been previously reported in the literature to our knowledge. A 15-year-old female presented with right ankle pain after a fall while roller skating. Imaging demonstrated a right Tillaux fracture with ipsilateral displaced medial malleolus fracture and minimally displaced Weber C distal fibula fracture. The Tillaux fracture and medial malleolus fractures were treated with open reduction and internal fixation with partially threaded compression screws. The lateral malleolus remained minimally displaced and did not require operative fixation. The patient healed well with no complications. Transitional injuries of the ankle in adolescents have been reported in the literature; however, combined injuries are uncommon and lack representation in the current literature base. These combined injuries are important to be aware of, as missed injuries can result in long-term pain and disability.
Highlights
Transitional ankle fractures occur during progressive closure of the distal tibia physis [1]
Tillaux fractures are typically the result of a dorsiflexion external rotation force resulting in avulsion of the anterior inferior tibiofibular ligament (AITFL) [1,2]
We present the case of a 15-year-old female with combined Tillaux and bimalleolar ankle fractures, a rare injury seldom discussed in the literature
Summary
Ankle fractures in skeletally immature patients have unique characteristics regarding fracture patterns and treatment, in patients with asymmetrically open physes transitioning to a mature, closed state. Initial anteroposterior (a) and lateral (b) radiographs of the injured right (R) ankle, demonstrating displaced medial malleolus and Tillaux fractures, as well as minimally displaced distal fibula fracture (fractures indicated by white arrows). A CT scan demonstrated greater than 2 mm of displacement of the Tillaux and medial malleolus fractures with minimal displacement of Weber C distal fibula fracture (Figures 2a, 2b). Intraoperative fluoroscopy was utilized to ensure good reduction of the medial malleolus and Tillaux fractures, appropriate screw placement, and no displacement of the fibula fracture (Figures 3a-3c). Intraoperative anteroposterior (a), mortise view (b), and lateral (c) fluoroscopic images demonstrating reduction of medial malleolus and Tillaux fracture fragments with appropriate placement of compression screws. Radiographs demonstrated well-healed distal fibula, medial malleolus, and Tillaux fractures (Figures 4a, 4b). The patient established care with a pediatrician in our system, who noted that she continued to have no ankle pain, swelling, or limitations 18 months postoperatively
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