Presentation
Twisted her ankle playing football, unable to bear weight on left ankle/foot
Patient Data
X-rays of the ankle in AP and lateral projections show a mildly displaced fracture of the distal tibial epiphysis with an extension of the fracture through the anterolateral growth plate. Mild soft tissue swelling is seen in the surrounding soft tissue.
A cast was applied and CT was requested by the trauma orthopedic team to look for further complexity and extension of the fracture.
CT scan demonstrates Salter-Harris III fracture with sagitally oriented fracture of the epiphyseal growth plate of the distal tibia and axial fracture through the anterolateral growth plate consistent with a 'Tillaux fracture'. The maximum displacement on the axial plane is 3 mm. No further fracture is seen.
Case Discussion
Tillaux fracture is a Salter-Harris type III fracture of the distal tibial epiphysis with the involvement of the anterolateral growth plate.
They are often seen in the pediatric age group with girls being more commonly affected than boys.
The management depends on the degree of fracture displacement, if that is <2mm, closed reduction is preferred and if displacement is >2mm surgery is the standard procedure.
Diagnosis can be made on standard ankle plain film radiographs, however, CT is often requested by orthopedic surgeons for pre-operative planning.
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