Chaput Tubercle Fracture in an Adult- A Rare Case Report

Abstract

A 33-year-old male presented to the causality of the hospital after encountering a road accident about an hour ago. The patient experienced a head on collision with another bike while driving his two wheeler. The patient complained of pain, contusion and swelling over the anterior aspect of left ankle. On examination, tender swelling with pain and restricted movement of ankle was noted. No associated history of vomiting, unconsciousness or any related injuries was found except the superficial abrasion over the dorsum of ipsilateral hand.The antero-posterior and lateral X-rays were carried out which revealed a suspicious intra-articular fracture of the antero-lateral part of the distal tibia. For the diagnostic confirmation the CT-scan of the left ankle was done, which confirmed the displaced Chaput tubercle fracture [Table/ Fig-1,2].The informed consent was taken from the patient and surgical intervention was planned. The antero-lateral approach was used for the open reduction. Intraoperatively the K-wire was used to manipulate the fracture as a "joystick" and fixed with canulated 4 mm lag screw . Postoperatively the POP slab and IV antibiotics (ceftriaxone and amikacin for three days) was given. Sutures were removed and ankle movement was started on postoperative day 11. Full range of movement was achieved in the next six days. Partial weight bearing started at sixth weeks of followup and the full weight bearing allowed at 10 th weeks. Patient was on regular follow up for one year and the Foot and Ankle Ability Measure (FAAM) score was 97% (100/116) and the patient has satisfactory clinico-radiological union [Table /Fig-4,5]. DISCUSSIONTillaux fracture occurs at the antero-lateral part of the lower end of tibial epiphysis and has a tendency to be displaced with the variable amounts. The epiphysis of distal tibia starts fusing from the middle, and first goes medially then the lateral side (12-14 years in female and 15-18 years in male). So that in the adolescent age group the Tillaux fracture is common because the lateral side of distal tibia is about to fuse which make it vulnerable for being avulsed when the anterior-inferior tibiofibular ligament (usually stronger than physis) fails to rupture during external rotation injury in the adolescents [1]. Since it is the transition period of epiphysiodesis which occurs during the adolescence to skeletal maturity so also known as transition fracture. The transition fracture of ankle is classified by Von Laer L as biplane and triplane fracture and the biplane fracture of epiphysis is analogous to Tillaux fracture [2].The triplane fracture of the lower tibial epiphysis was first described by Marmor and has transverse component through growth plate, coronal component through posterior tibial metaphysic (Salterharris type II or IV in lateral view) and saggital component (Salterharris type III in AP view) in distal tibial epiphysis [3]. On the contrary the Tillaux fracture is a biplane fracture, so the radiological diagnosis of Tillaux fracture is utterly arduous due to t...

The rare isolated adult Chaput-Tillaux fracture: two case reports and review of the literature

“…CT scan) to evaluate all fracture planes, but also to detect other fractures, articular fragments and articular compatibility. 1,6,8,20,21 It should be noted that Liporace et al did not found inter-and intra-observer differences in primary treatment plans between radiographs and radiographs plus CT. 24 Recently, Ito et al reported the first malunion case in a CTF, following conservative treatment, where a corrective osteotomy at the original fracture side was performed to due to persistent pain five months post-injury. 4 Nevertheless, it was not an isolated CTF-a concomitant medial fracture was also detected by the time of sprain.…”

“…6,[9][10][11][12][13] The vulnerable growth plate may not be fused until 14 years in girls and 18 years of age in boys. [6][7][8]11,14,15 The adult Tillaux fracture, also recognized as CTF, has a relative incidence of 12% in transmalleolar fractures but the frequency as isolated bony avulsion remains unknow. [16][17] It is classified as AO/OTA43B.…”

“…Seldomly, the ligament fails to rupture and the anterolateral tibial plafond is avulsed-off-Chaput-Tillaux fracture (CTF). 1,6,7,8 In addition to the presented cases, complementary diagnostic exams, outcome data and a literature review was conducted. Informed consent was obtained from the patients involved in the study.…”

Tillaux fracture in adults – Case report and review of literature

“…Feng et al in 2018 8 However, as in our case, previous studies reporting open reduction, did not report evidence of complications or infection. 2,9,10,11,6,5,4,12,3,13 Regarding X-ray assessment of articular alignment in closed reduction versus intraarticular direct surface assessment in open reduction, no evidences of poor functional mid-term outcomes have been reported.…”

Fratura de Tillaux não percebida e lesão por sindesmose em adultos: Redução e fixação artroscópica assistida

“…1 Esse tipo de lesão é raramente observado em adultos com maturidade esquelética porque o ligamento tibiofibular anterior geralmente se rompe primeiro. [2][3][4][5] As fraturas intra-articulares requerem redução e estabilização anatômicas para evitar complicações como instabilidade do tornozelo, dor no tornozelo e osteoartrite pós-traumática. 4,6 A artroscopia tem várias vantagens em relação às abordagens abertas, permitindo um tratamento menos agressivo das lesões associadas, melhora da redução intra-articular e com menos complicações.…”