Tillaux Fracture

1. Ankle Case # 5

2. History and Physical 13YOM presents with the complaint of ankle pain. The patient was hiking with friends and family when his foot got caught and he “twisted” his ankle. He has been unable to bear weight and is complaining of marked swelling. T 98.7 P 98 BP 126/84 O2 99% Gen: WDWN, obvious pain CV: RRR, no m/r/g Pulm : Lungs CTA bilat Musc : Limited active and passive ROM R ankle; marked swelling and TTP of anterior R ankle; no TTP over medial and lateral malleolus

3. Images

4. Diagnosis: Tillaux Fracture Red arrow: Salter Harris III fracture involving avulsion of anterolateral tibial epiphysis

5. Pain control Orthopedic Consultation for possible ORIF Displacement of >2mm requires ORIF Stabilization/Closed Reduction Internal rotation of ankle and supination of the foot with pressure on fracture fragment Stabilization in long leg cast or stirrup splint with posterior slab Prompt orthopedic follow-up ED Management

6. Fracture occurs in adolescents w/ relatively mature growth plates; therefore, there is minimal potential for deformity due to growth plate injury Needs to be differentiated from a triplane fracture, which is a salter harris IV fracture that extends through the epiphysis, physis , and metaphysis Pearls

7. Additional Images

8. http://www.radpod.org/2007/07/20/tillaux-fracture/ http://radiologyschools.com/Radiology-Courses/ext/8ankle/33.html http://www.wheelessonline.com/ortho/tillaux_fracture http://www.joint-pain-expert.net/tillaux-fracture.html Pediatric Emergency Medicine. Chapter 38 Injuries of the Pelvis and Lower Extremities References