Painful Nonunion after Missed Juvenile Tillaux Fracture in an Athlete - Case Report and Description of a New Fixation Technique (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.
Oblique Compression Screw Fixation across the Physis for Tillaux Fractures in Adolescent
Objective: Tillaux fractures are uncommon physeal injuries sustained by adolescents. Two different fixation techniques are described; the first involves placement of a screw obliquely into the tibial metaphysis, while the second involves placement of a screw parallel through the epiphysis without violating the physis. The purpose of this study was to report the outcomes, complications, and advantages of oblique screw fixation.
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
Orthopaedic Surgery and Traumatology Case Report The Tillaux Fracture in Adult
2017
We describe a bimalleolar fracture of the right ankle in a 24 year old man with an associated ankle subluxation and fracture of the anterolateral aspect of distal tibia-the adult tillaux fracture. Adult tillaux fracture is an extremely rare fracture pattern with very few cases reported in the literature. The case described is of a 24 year old male who sustained the injury while trekking in the hills. Careful evaluation of x rays AP, lateral and oblique views are helpful in identifying the tillaux fracture. We would also recommend evaluation with CT. The case was seen in emergency 12 hours after the fall. He presented with a swollen ankle and foot. Skin overlying the medial mal-leolus had abrasions and gross ecchymosis. Distal neurovascular status was intact. X rays showed fracture of the lower fibula, medial mal-leolar fracture with separation of the malleolus, subluxation of talus with disruption of the ankle joint and fracture of the antero lateral aspect of distal tibia. The pati...
Treatment for displaced Tillaux fractures in adolescent age group
Foot and Ankle Surgery, 2020
Limitations of the study: Although our series is one of the largest series of the literature and one of the series with longest follow-up, we believe that a larger series with longer follow-up and with control groups are necessary for more strict conclusions. Conclusion: Our study shows that anatomically reduced Tillaux fractures at adolescent age group either by closed or opened means, followed by postoperative plaster cast immobilization will lead to excellent results.
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...
Journal of pediatric orthopedics. Part B, 2018
The goal of this study was to compare open reduction versus percutaneous fixation of adolescent ankle fractures with regards to the incidence of growth disturbance. We performed a retrospective cohort analysis of adolescent patients with triplane or Tillaux fractures. There was an even distribution of triplane fractures and mean initial displacement between cohorts. Analysis of follow-up radiographs revealed no instances of growth disturbance in the percutaneous fixation group and six in the open reduction group (P=0.29). Growth disturbance does not pose a significant concern when selecting a surgical approach. Owing to the rarity of these fractures this study was underpowered.
Physeal Injuries of the Ankle in Children
Clinical Orthopaedics and Related Research, 1978
In the adult ankle, Lauge-Hansen' studies showed that 2 elements are important in ankle injuries, as follows: (1) position offoot at the moment of trauma; (2) direction of abnormal force. These principles are now well accepted. The mechanism of trauma in ankle epiphyseal injuries has been studied in the past. Bishop2 classified ankle fractures in children by modifying the Ashhurst-Bromerl classification. other^,^'^ utilized the same classification. These classifications are rather inaccurate regarding the degrees described and do not consider the foot position as part of the mechanism of injury. The purpose of this paper was to devise a clearer and more comprehensive classificationusing Lauge-Hansen guidelines, foot position and direction of force in correlation with the Salter-Harris classification. Four mechanisms should be considered (Table 1). Ineachthefirsttermrepresents the fixed position of the foot at the time of the injury; the second is the direction of abnormal force being transmitted to the anklejoint. For each mechanism, grades are described. Each grade always occurs in the same order