Tillaux fracture

Background

  • Salter-Harris type III fracture of the anterolateral portion of the distal tibia
    • caused by an avulsion of anterior inferior tibiofibular ligament
  • Occurs typically in adolescents, age 12-14
    • occurs in children nearing skeletal maturity, as anterolateral portion most vulnerable at this age

Clinical Features

  • Typically due to external rotation force
    • forced lateral rotation of foot OR medial rotation of leg on a fixed foot
  • Often associated with external rotation deformity of the ankle/foot

Differential Diagnosis

Distal Leg Fractures

Evaluation

  • XR
    • Salter-Harris III fracture of anterolateral distal tibia epiphysis
  • CT scan
    • further delineates fracture pattern and degree of displacement

Management

General Fracture Management

  • Acute pain management
  • Open fractures require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
  • Consider risk for compartment syndrome
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Specific Management

  • Ortho consult

Disposition

  • Most will require surgical reduction
  • Admit

Specialty Care

  • Nonoperative
    • closed reduction, long leg cast x 4wks, short leg cast x 2-3wks
    • indicated only if <2mm of displacement after closed reduction (rare)
  • Operative
    • Open reduction and internal fixation (ORIF)
    • indicated if >2mm of displacement after reduction attempt

See Also

External Links

References