Abstract
BackgroundThe concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern.MethodsThe charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores.ResultsThe mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6–8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7.ConclusionsComputerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.
Highlights
The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult
Five Tillaux fractures and all medial malleolar fractures (MMF) were shown on AP radiographs
One Tillaux fracture and two Avulsion of posterior inferior tibiofibular ligament (APITEL) were confirmed in axial computerized tomography (CT)
Summary
The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. Physeal injuries of the distal tibia are second in frequency to those of the distal radius and carry a high risk of complications. Tillaux fracture accounts for approximately 2.9–6.7% of the distal tibial epiphyseal fractures [1, 2]. It usually occurs in adolescents when the center and medial side of the distal tibial physis have been closed and the anterolateral quadrant fusion does not occur. No Gender Age (years + Interval Lateral Cause Associated injuries TMM DT (mm) SD Treatment Complications months) (days).
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