Posteriorly Displaced Fragment in a Juvenile Tillaux Fracture: A Case Report.

Abstract

Fractures of the distal tibial and fibular physes account for 25% to 38% of all physeal fractures1. The juvenile Tillaux fracture corresponds to a Salter-Harris type-3 injury involving the anterolateral distal tibial epiphysis. This intra-articular fracture, which typically occurs in young teenagers as they approach skeletal maturity, is described as a transitional injury because it happens only with a partially fused distal tibial physis. The incidence varies from 2.9% to 5.2% of physeal injuries1,2, and from 3% to 5% of all ankle fractures3. The Tillaux fracture’s pattern, mechanism, and management are well described4,5. The typical mechanism of injury is inversion with external rotation, leading to avulsion of the portion of the lateral tibial epiphysis that is attached to the anterior tibiofibular ligament. The physis underlying the uninvolved medial part of the epiphysis is closed. Treatment recommendations for this injury are based on the extent of displacement of the fragment. Nondisplaced or slightly displaced fractures can be treated conservatively, whereas displacement of more than 2 mm requires closed or open reduction to restore articular congruity1,4. Typically, the Tillaux fragment displaces laterally or anterolaterally3. Steinlauf et al. reported a study that mentions entrapment of the Tillaux fragment between the tibia and fibula, simulating a syndesmosis separation6. To our knowledge, there are no prior published reports of posterior displacement of the fragment. We report a case of a posteriorly displaced Tillaux fragment with an associated fracture of the distal part of the fibula. The latter injury may have permitted the posterior displacement of the Tillaux fragment. The purpose of this report is to create awareness of this unusual injury …