Juvenile Tillaux Fracture Research Articles

Juvenile Tillaux Fractures: A Comparison of Direct and Indirect Fixation

Juvenile Tillaux Fractures: A Comparison of Direct and Indirect Fixation

Osteotynthesis with ankle arthroscopy for Juvenile Tillaux fracture. A case report

Osteotynthesis with ankle arthroscopy for Juvenile Tillaux fracture. A case report

Juvenile Tillaux骨折にS-H 4型骨端線損傷を合併した1例

Juvenile Tillaux骨折にS-H 4型骨端線損傷を合併した1例

Asisstance Arthroscopy in Juvenile Tillaux Fractures

Introduction:Juvenile Tillaux Fracture is an isolated fracture of the lateral portion of the distal tibial epiphysis, considered SALTER-HARRIS fracture type 3, wherein the fragment is moved by the anterolateral ligament anterior inferior tibiofibular. They occur at the beginning of the 2nd decade of life and are caused by a force external rotation. The pattern of injury is considered a result of the closing sequence of the distal tibial physis, which usually closes around 15 years of age in girls and 17 in boys, this process usually takes about 18 months, occurring first in the central area of the physis, extending medially and finally to side, being this epiphyseal portion which is open at the time of the vulnerable to fracture injury in this age group. The curriculum includes RX, and TAC, being more sensitive to detect fragments of 2 or more mm of travel, but may overestimate the true displacement. The non-displaced fracture can be treated with cast immobilization and displaced with closed reduction (plantar flexion external rotation in the pronated foot and direct pressure on the anterolateral epiphysis). An equal displacement or > 2 mm of the articular surface is indication of open reduction and percutaneous fixation, because it may increase the risk of osteoarthritis in the future.Objective:Presentation of a case Juvenile Tillaux Fractures with surgical resolution under arthroscopic assistance.Methods:Male patient 14 years old who suffered indirect trauma left ankle during practice sports (rugby) in September 2015, 48 hours of evolution. After performing X-rays and scans one left Salter Harris type III at the level of distal tibial epiphysis (Tillaux fracture) ankle fracture was diagnosed. It had a greater than 2 mm displacement. As a reduction treatment and percutaneous osteosynthesis with more osteodesis screw with arthroscopic assistance and fluoroscopy was performed. After surgery a long leg cast was placed for three weeks, continuing with three other short boot. By the third week the plug removal. After the sixth week began with partial load with Walker boot for a month and later full charge.Results:Fracture healing was evident in the eighth week. Now in his eighth postoperative month and has an excellent performance according to the AOFAS score of 96 points, with no pain, full range of motion and return to sport after 4th month.Discussion:There are reports such as A. Kaya et.al (2007) with excellent results (AOFAS 99.3) in a series of 10 patients treated by open reduction and internal fixation and in other hand A. Panagopoulus, L.van Kiekerk (2007) reports excellent results (AOFAS 100) in patients treated under arthroscopic assistance. Assistance arthroscopy in Tillaux fractures allows a reduction more accurate than that provided by percutaneous techniques fluoroscopy guided only by avoiding the problems associated with open techniques (lesion of the superficial peroneal nerve and necrosis of the fragment). It also allows patients to an early return to activities with a lower risk of stiffness and secondary osteoarthritis due to the reduction achieved under direct arthroscopic visualization.

Pediatric Tillaux Ankle Fracture with Concomitant Adult-type Supination External Rotation Fracture Pattern: A Rare Injury

ABSTRACT The juvenile Tillaux fracture is a transitional ankle fracture that occurs in the adolescent population. The juvenile Tillaux fracture is an avulsion injury of the distal tibia's anterolateral epiphysis as the result of excessive external rotation. The purpose of this article is to present a pediatric ankle fracture that is best described as a supination-external rotation type IV ankle injury with an associated Tillaux fragment. This fracture pattern represents a unique variant to classically described pediatric ankle fractures. Dial BL, Morwood MP, Fitch RD. Pediatric Tillaux Ankle Fracture with Concomitant Adult-type Supination External Rotation Fracture Pattern: A Rare Injury. The Duke Orthop J 2016;6(1):61-63.

Simultaneous, Bilateral Triplane and Juvenile Tillaux Fractures in a 13-yearold Boy: A Case Report and Discussion

Pediatric Triplane and Tillaux fractures represent a continuum of Salter-Harris injuries of the distal tibia. Over an 18-month period in children 12 to 15 years of age, the distal tibial physis closes first centrally, than medially and finally laterally. It is this unique and asymmetric pattern that makes them vulnerable to these injuries, with the Tillaux fracture historically occurring in slightly older children than the triplane fracture. However, we present a case and discussion of a 13-year-old male who incurred simultaneous Tillaux and Triplane fractures.

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

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 …

Juvenile Tillaux fracture with disrupted anteroinferior tibiofibular ligament: a case report

The juvenile Tillaux fracture is an avulsion fracture of the anterolateral corner of the distal tibial epiphysis. This type of fracture occurs when the anteroinferior tibiofibular ligament, with the foot position of supination-eversion or external rotation, avulses an epiphyseal fragment. Therefore, the anteroinferior tibiofibular ligament plays an important role in this injury, and usually remains intact. Here, we present a case in which the distal epiphyseal fragment was severely displaced and inverted, and the anteroinferior tibiofibular ligament was totally disrupted.

Arthroscopic Assisted Fixation of Juvenile Intra-articular Epiphyseal Ankle Fractures

The purpose of this study was to present the long-term follow-up of a case series of arthroscopically assisted fixation of juvenile intraarticular epiphyseal ankle fractures. The functional and radiographic outcomes of 6 patients with a range of follow-up of 1 to 5 years were evaluated. Five of the 6 patients had triplane injuries, whereas the remaining patient sustained a juvenile Tillaux fracture. All of the patients returned to full activity within 14 weeks of surgery, and none of the patients had any restriction in the ankle range of motion at the time of last follow-up. The results of this small series of patients suggest that arthroscopic-assisted, percutaneous fixation of intraarticular juvenile epiphyseal ankle fractures is an effective, less invasive surgical technique. Several surgical maneuvers that are helpful in the consistent execution of this technique are also mentioned.

Isolated Juvenile Tillaux Fracture: A Case Report

Tillaux fractures are relatively uncommon SalterHarris type III fractures involving avulsion of the anterolateral tibial epiphysis. We present the case of a 16 year old boy who sustained and isolated Tillaux fracture and discuss it management. CASE REPORT A 16 year old boy attended the Accident and Emergency department with an injury to his right foot. He sustained the injury while wrestling, after his opponent landed on his right foot. A “crack” was heard and he was unable to weight bear. On examination there was mild swelling around the ankle joint and tenderness over the lateral malleolus. The skin was intact and there was no neurovascular deficit. Radiographic images of his right foot are shown below (Fig 1). Figure 1 Figure 1: Radiographes showing isolated Tillaux fracture. A diagnosis of Tillaux fracture was made and the patient was scheduled to undergo open reduction and internal fixation. Following an anterolateral incision, the fragment was identified, reduced and fixed with a fully threaded 45mm cancellous screw (Fig. 2). The patient was immobilised with below knee cast and was instructed to non-weight bear with crutches for 4 weeks. Post-operative plans include progressive weight bearing after 4 weeks and removal of the screw once the fracture has healed. Figure 2 Figure 2: Intraoperative images showing stabilisation of the fracture by cancellous screw Isolated Juvenile Tillaux Fracture: A Case Report

Arthroscopic treatment of a juvenile tillaux fracture

Tillaux fractures are relatively uncommon fractures of the anterolateral tibial epiphysis that are observed in adolescents during the 18-month period when the distal tibial physis has begun to fuse centrally. The case of a 16-year-old boy with a juvenile Tillaux fracture treated successfully by reduction and percutaneous fixation under arthroscopic control is presented. The procedure is technically feasible, allows accurate reconstruction of the weight bearing surface of the joint and secure internal fixation of the fracture. The authors describe the principles of the procedure and discuss its advantages compared to open surgery.

Open reduction and internal fixation in displaced juvenile Tillaux fractures

Juvenile Tillaux fracture is relatively an uncommon injury for which there appears no established treatment protocol. Ten patients with juvenile Tillaux fractures were treated by open reduction and internal fixation and the results were evaluated by an objective scoring system. At the latest follow-up (32-75 months) mean score was 99.3 (97-100) by the score of American Orthopaedic Foot and Ankle Society. Radiographically all fractures had healed in anatomical position. Treatment of juvenile Tillaux fractures with 2mm or more displacement by internal fixation without any attempt of closed reduction gives excellent results.

Arthroscopic assisted reduction and fixation of a juvenile Tillaux fracture

We report a case of Tillaux fracture of the distal tibia in a 14-year-old patient. Reduction and fixation of the fracture was achieved arthroscopically through the anterolateral portal. The patient was able to participate in competitive athletic activities 3.5 months after surgery with an AOFAS score of 100. Arthroscopy is an expedient tool in the management of intra-articular fractures of the ankle providing anatomical reduction under direct visualization with minimum intervention.

Rare Injuries to the Distal Tibiofibular Joint in Children

Injuries to the distal tibiofibular junction have been very precisely described in adults including diagnosis and treatment. By comparison, only two types of epiphyseal fracture were described as the equivalent of such an injury in the growing skeleton until now: the juvenile Tillaux fracture and the lateral triplane fracture. During a five-year period (1997 - 2001) twenty children with distal tibiofibular joint injury were treated in our department. Three previously unpublished types of epiphyseal injury to the distal tibial mortise are presented: intraepiphyseal fractures of Chaput's tubercle type 7A and 7B according to Ogden's classification (in two and one cases, respectively) and an intraepiphyseal subcortical tibial mortise disruption (one case). The authors suggest that these three types are transitive types between juvenile Tillaux fracture in children and disruption of the distal tibiofibular syndesmosis in adults. All three types were without significant displacement and were stable in stress positions of the ankle joint. Thus, the treatment was nonoperative with excellent results and without sequelae.

Juvenile Tillaux ankle fracture pattern in a skeletally mature adult

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.

Arthroscopically assisted reduction and fixation of a juvenile Tillaux fracture

This is the first report of arthroscopically assisted reduction and fixation of a juvenile Tillaux fracture. Arthroscopic visualization assisted with the anatomic reduction of the articular fragment. This adds arthroscopy as a modality available to help obtain accurate reduction as well as understand the nature of the fracture pattern in juvenile Tillaux fractures along with its adult counterpart and other intra-articular fractures.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 4 (April), 2002: pp 427–429

Radiologic Evaluation of Juvenile Tillaux Fractures of the Distal Tibia

This study evaluated the accuracy of plain radiographs and computerized tomography (CT) in assessing juvenile Tillaux fractures of the distal tibia. A simulated Tillaux fracture was made in four cadaver specimens and displaced 0, 1, 2, 3, and 5 mm. Plain radiographs and CT were performed on each specimen at each amount of displacement, and the results were compared with the actual amount of displacement present. Plain radiographs and CT were accurate within 1 mm in depicting the actual fracture displacement about 50% of the time. CT was more sensitive than plain radiographs in detecting fractures with >2 mm of displacement. Fracture displacement of >2 mm is generally considered an indication for fracture reduction. Because of its sensitivity in detecting fractures displaced >2 mm, CT is the preferred imaging modality in the assessment of juvenile Tillaux fractures.

Ｊｕｖｅｎｉｌｅ Ｔｉｌｌａｕｘ骨折の２例

The juvenile Tillaux fracture is a Salter-Harris Type III intraarticular fracture of the ankle in adolescent children whose distal tibial epiphysis is partially closed. This fracture is caused by the avulsion of the lateral portion of tibial epiphysis by inferior tibiofibular ligaments during the lateral rotation of the foot at the ankle.We treated two cases. Both cases were examined with CT scan, underwent open reduction and internal fixation with bioabsorbable osteosynthetic implants. The range of motion and functional results were excellent. When displacement is more than 2mm, open reduction and internal fixation should be performed to reduce the articular surface.

Physeal fractures aboutthe ankle and osteochondral lesions of the talus in the skeletally immature athlete

In children and adolescents, many sports related ankle injuries result in physeal fractures. Excessive forces applied tothe skeletally immature ankle commonly result in Salter Harris 11, 111, and IV fractures. To minimize the potential for growth disturbance of the distal tibia and articular incongruity of the ankle joint, reduction with fixation is recornmended for fractures displaced greater than 2 mm. Transitional fractures of the ankle, ie, the juvenile Tillaux and triplane fractures, occur in the older adolescent athlete. Restoration of the articular surface is of primary importance in treating these injuries. Osteochondral lesions of the talus are often the cause of persistent ankle pain after a seemingly minor ankle injury. Immobilization and progressive rehabilitation are successful in treating the majority of these injuries in the immature athlete. Arthroscopic treatment techniques are recommended for treatment of osteochondral lesions not responsive to conservative measures.

Juvenile Tillaux fracture of the ankle associated with a tibial shaft fracture: a unique combination

Juvenile Tillaux fracture of the ankle associated with a tibial shaft fracture: a unique combination