Tillaux fracture

Last revised by Arlene Campos on 11 Jan 2024

Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement.

It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse.

The fracture commonly results from an supination-external rotation mechanism. With this mechanism, the inferior anteroinferior tibiofibular ligament avulses the anterolateral corner of the distal tibial epiphysis 3.

The fracture requires an open physis (the lateral aspect of the distal tibial physis usually closes between 12 to 15 years of age while the medial aspect closes earlier). The lateral epiphyseal involvement is due to growth plate fusion commencing from medial to lateral aspect.

Vertical fracture through the distal tibial epiphysis (Salter-Harris III) with a horizontal extension through the lateral aspect of the physis. No metaphyseal fracture is present - a coronally oriented metaphyseal fracture in addition to the Tillaux fracture constitutes a triplane fracture.

The degree of displacement will dictate management. Open reduction and internal fixation (ORIF) is required when the displacement is marked or cannot be corrected with closed reduction.

As with any intra-articular fracture, a persistent articular surface step predisposes the joint to premature secondary osteoarthritis.

This fracture pattern is named after Paul Jules Tillaux, French surgeon and anatomist (1834-1904) 2.

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