Abstract
We report two cases of isolated Tillaux fracture and Volkmann fracture without other associated ankle fractures. The case of Tillaux fracture was a 15 year-old female who tripped and fell over during a 400 m hurdle running competition. Preoperative radiographs and CT scans showed Salter-Harris type III, an isolated Tillaux fragment, with more than 2 mm anterior and lateral displacement. Surgical stabilization of Tillaux fragment was performed via anterolateral minimal invasive approach with anatomic reduction of Tillaux fragment and two parallel cannulated screw fixation. The second case was a 21-year-old female who fell off a snowboard with her ankle in an odd position. Preoperative radiographs did not reveal any bony injuries. However, CT scans showed a Volkmann fracture at the posterolateral aspect of posterior malleolus without displacement. Non surgical management was given, after intraoperative imaging intensifier screening to confirm that there was no syndesmotic diastasis. The mechanism of injury and options of management are discussed in this report.
Highlights
In Lauge-Hansen classification of ankle fractures [1], four major fracture types were described: supination- adduction, supinationexternal rotation (SER), pronation-abduction, and pronation-external rotation (PER) fractures
We present two cases who had isolated Tillaux or Volkmann fractures that are different from those fractures combined with other ankle bony injuries in literature [5,6] and our treatment methods were determined by syndesmosis instability
Gardmer MJ, et al [10] did cadaver PER injury with posterior malleolar fragment model and fixation of posterior malleolus that restored 70% syndesmotic stability compared with fixation of syndesmosis that restored 40% stability and notably, for osteoarthritis, 95% of patients had no signs of osteophytes, suggesting a low risk of developing osteoarthritis after fixation of posterior malleoli
Summary
In Lauge-Hansen classification of ankle fractures [1], four major fracture types were described: supination- adduction, supinationexternal rotation (SER), pronation-abduction, and pronation-external rotation (PER) fractures. The patient was managed operatively via anterolateral minimal invasive approach, anatomic reduction of Tillaux fragment and stabilized with two parallel cannulated screws (Figure 4) She was in a non-weight bearing boot for 6 weeks, and was allowed to do range of movement of her ankle. She had injured the ankle a day earlier while snowboarding Examination of her ankle revealed mild pain on the range of movement, no tenderness over medial and lateral aspect of her ankle. The post injury radiographs were generally normal (Figure 5) Her CT scan of the ankle revealed a Volkmann fracture (Figure 6). A shot leg plaster was applied for six weeks She was reviewed in clinic in one-year post-injury, and was pain-free
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