Bilateral Distal Tibial Transitional Ankle Fractures (original) (raw)
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Adolescent Tillaux Fractures: A Systematic Review of the Literature
Cureus
The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are transitioning to skeletal maturity. Owing to its rarity, the optimal management strategy for this fracture is not well-described. The aim of this review was to assess the outcomes of operatively and nonoperatively managed displaced adolescent Tillaux fractures. We analysed articles from The Cochrane Library, PubMed, MEDLINE, and EMBASE databases that met our predetermined inclusion and exclusion criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. A descriptive data analysis was performed. A total of 461 articles were identified from the data search, of which 13 articles were included for full-text analysis. Five of these studies reported recognised patient outcome measures and the remaining eight reported on radiographic follow-up. The reported studies included a total of 114 patients with Tillaux fractures; 58.8% of patients were female and 34.2% were male. Mean ages ranged from 12.5 to 15 years, with the youngest patient being 12 years old and the oldest 17 years old. Overall mean follow-up was 42.8 months. Of the patients, 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically. The remainder were treated nonoperatively. Outcome measures were excellent for all patients irrespective of operative management choice. Follow-up radiographic deformity was only evident in Tillaux fractures that were managed nonoperatively; deformity included poor joint congruity, angular deformity, and tibial shortening. These nonoperative patients have a residual fracture displacement of 2 mm. There were no reported instances of premature physeal closure for any patient. This review shows that excellent patient outcomes have been reported for different methods of operative fixation, however, study sizes are small and data is sparse. Further robust comparative studies are required to identify definitive conclusions. The use of established clinical and radiographic outcome measures will help improve the quality of future studies for this relatively rare injury.
The triplane fracture of the distal tibial epiphysis in children
Injury-international Journal of The Care of The Injured, 1981
Two cases of triplane fracture of the ankle in children are presented. Both patients were treated conservatively with good results. The typical age incidence and difficulties in establishing the diagnosis by X-ray examination are discussed. Closed reduction and plaster immobilization is recommended. Only if joint congruity cannot be restored is operative treatment required.
Asisstance Arthroscopy in Juvenile Tillaux Fractures
Orthopaedic Journal of Sports Medicine, 2017
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 w...
The Duke Orthopaedic Journal, 2016
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.
Displaced juvenile Tillaux fractures
Wiener klinische Wochenschrift, 2016
Background Approximately 15 % of all juvenile injuries of the long bones involve the epiphyseal growth plate, and 2.9 % of these are juvenile Tillaux fractures. The Tillaux fracture is of great importance because it involves a major weight-bearing articular surface. Treatment protocols in the literature are not uniform for this kind of fracture, and numerous case reports can be found describing various treatment methods. The aim of this study was to present the clinical outcome at long-term follow-up after treatment of displaced Tillaux fractures. Methods In all, 168 children and adolescent patients with physeal injuries of the distal tibia were treated
Concomitant Tibia Shaft and Distal Triplane Fractures
2018
Concomitant tibia shaft fracture and triplane fracture of the distal tibia are very rare in the pediatric orthopaedic traumatology. The very limited number of cases in the world literature has all been documented in adolescent patients. Appropriate diagnostic evaluation and treatment is required to minimize the incidence of delayed or missed diagnosis of the ankle injury, prevent complications and optimize outcomes of both fractures. A new case as well as an extensive review of the literature is presented in this editorial.
Journal of Orthopaedic Case Reports, 2018
Introduction: The Tillaux fracture is a rare subtype of tibial physeal fracture that usually occurs in adolescents. There are only a few case series or reports published in the literature and, to our knowledge, this is the first time, a painful nonunion is reported after this type of fracture. Case Report: A 13-year-old athlete presented to our orthopedic department because of persistent pain after an acute ankle injury 2months before. She was diagnosed with a Tillaux fracture that eventually progressed to nonunion after conservative treatment. Surgery was performed to treat the nonunion, and the fracture fragment was fixed using a soft suture anchor. Conclusion: The Tillaux fracture pattern requires a high level of clinical suspicion and careful evaluation since it can be misdiagnosed as a simple ankle sprain in adolescents and progress to persistent ankle pain without appropriate treatment. Our surgical technique of suture anchor fixation avoids the risk of fragmentation of the fr...
Triplane fractures of the adolescent ankle—a report of three cases
Injury, 1985
Three cases of triplane fractures of the distal end of the tibia are presented. There are usually two or three fragments and it occurs in adolescents in whom there is little growth potential left; hence there is little growth disturbance despite premature closure of the physis. The key to successful treatment is to assess the degree of articular deformity and to restore articular congruity.