The adult Tillaux fracture: one not to miss

Abstract

This case is a rare adult type Tillaux fracture. This fracture should be diagnosed in the emergency department. The fracture requires careful evaluation with awareness of associated injury. Standard radiological views (antero-posterior and lateral) of the ankle may not clearly show the fracture displacement hence, an oblique view is required. The fracture should be managed by the emergency physician, if the displacement is less than 2 mm, by immobilising with a non-weight bearing cast or ankle braces for 6 weeks. If the fracture fragment is displaced more than 2 mm, it should be treated by closed reduction failing which open reduction and internal fixation is the standard practice.

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

“…7 In this population, the susceptibility of the anterolateral tibial aspect to a forced supination and external rotation is explained by the well-known asymmetric physiologic physiodesis: it starts to close centrally, fusion then progresses medially with the anterolateral portion fusing last. 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.…”

“…19 The conservative treatment adopted by some authors, despite satisfactory outcomes, is no longer recommended. 12,25 Appropriate surgical treatment is controversial and research is still ongoing. The size of the fragment should be considered in the preoperative assessment as well as the integrity of the AITFL.…”

Tillaux fracture in adults – Case report and review of literature

“…Conservative treatment indications seem to be clear, including those Tillaux fractures with lower than 2 mm displacement. However, it seems an atypical choice (9%, 3/34) 4,6,7 , and two of them (67%, 2/3) did not underwent diagnostic CT scan and failed to report complications. 6,7 Moreover, treatment option recommendations vary widely, with great disparity of treatment.…”

“…However, it seems an atypical choice (9%, 3/34) 4,6,7 , and two of them (67%, 2/3) did not underwent diagnostic CT scan and failed to report complications. 6,7 Moreover, treatment option recommendations vary widely, with great disparity of treatment. ranging from 1 week of cast immobilization followed by walker, to above the knee cast 6 for the first 3 weeks and then followed by a below the knee cast for the next 5 weeks.…”

Projection radiography of the ankle; the views used for different indications vary between medical imaging departments

“…When a fracture is suspected, studies have shown that more fractures are found with three views than two [10] and recent studies suggest that three views are common practice [11]. It has also been acknowledged that standard views may not clearly show some fractures [12]. An Icelandic book on radiographic positioning, which has been an important source for radiographers the last three decades, describes four ankle views: AP, mortise, lateral and oblique lateral, but directions about when to use each view are not provided [13].…”