Tillaux Fracture

Excerpt

Pediatric fractures most frequently involve physeal plates in 12% of long bone fractures. These physes are cartilaginous and represent the weakest parts of a bone. Tillaux fracture represents 2.9 % of juvenile epiphyseal growth plate injuries . In a Tillaux fracture, the asymmetrical closure of the distal tibial physeal plate contributes to the mechanism of injury in such a way as to create the classic Tillaux fracture pattern in adolescent patients. This fracture is classified as a Salter-Harris type III fracture and is, therefore, an intraarticular fracture. The physis involved is the distal tibial physis, and the intraarticular portion of the fracture pattern involves the distal tibial bony epiphysis. The fracture is named for Paul Jules Tillaux who was a French physician who practiced medicine and surgery in Paris. In 1892 he was the first physician to describe the Salter-Harris type III fracture of the distal tibia. The fracture has been described as an isolated injury. However, association with a distal fibula fracture either Salter-Harris I or II or ipsilateral distal tibial shaft fracture can occur.

Clinical anatomy: at the lateral distal end of the tibia, there is a triangular concavity for the distal fibular shaft. Distal to this concavity, there are anterior and posterior tibial tubercles. The interosseous ligament attaches the tibia to the fibula at the level of the triangular concavity and forms part of the ankle syndesmosis. Other parts of the syndesmosis are; the anteroinferior tibiofibular ligament, which attaches to the anterior tibial tubercle (Chaput Tubercle), and the anterior aspect of the lateral malleolus (Wagstaffe tubercle), and the posteroinferior tibiofibular ligament, which attaches to the posterior tibial tubercle to the posterior aspect of the lateral malleolus .