Juvenile Tillaux ankle fracture pattern in a skeletally mature adult

Abstract

Closure of the growth plate begins in adolescence, leading to unique fracture patterns in this age group. By approximately age 13, the distal tibial epiphysis closes centrally and then medially, with the anterolateral side of the distal tibial physis closing last [1,2]. This pattern of physeal closure makes the anterolateral portion of the distal tibia epiphysis susceptible to an avulsion injury by the distal anterior tibiofibula ligament. The juvenile Tillaux fracture is defined as a Salter Harris III fracture of the distal tibial anterolateral epiphysis. These fractures typically occur in children between the ages of 12–14 and account for 3–5% of pediatric ankle fractures. The mechanism of this fracture is typically supination with external rotation [1,2]. With external rotation, the anterior inferior tibiofibular ligament becomes taught and after additional force, the anterior tibial lateral epiphysis fractures, with the size of the fragment depending on the extent of the fusion medially [3]. In adults, the supination external rotation mechanism often causes a direct bony avulsion of the anterior inferior tibiofibula ligament. We have found reports that associate Tillaux fractures with syndesmotic injuries [3,4]. We present the case of a 19-year-old skeletally mature male who sustained a displaced intraarticular distal tibia fracture in which the fracture plane exited anterolaterally through the physeal scar.