Age / Sex : 12 / F

Tillaux fracture

Discussion

Findings:

Plain & CT :

There is an
avulsion fracture through the anterolateral aspect of the distal tibial
epiphysis (Salter-Harris III fracture in this case).         

Differential Diagnosis:

None

Discussion:

Tillaux fracture is the second most common
growth plate fracture1 and is usually a Salter-Harris III fracture, or rarely a
Salter-Harris IV fracture, of the distal tibia.

Epidemiology

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

Pathology

The fracture commonly results from an abduction-external
rotation mechanism. With this mechanism the anterior tibiofibular ligament
avulses the anterolateral corner of the distal tibial epiphysis.

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.

Figure 1. Fusion of the distal tibial physis begins centrally. Fusion
progresses medially - the lateral physis may remain open for up to six months
or one year.

Radiographic features

The lack of a fracture component in the
coronal plane (evaluated with lateral x-ray or CT) distinguishes a Tillaux fracture
from a triplanar fracture.

References:

Simon WH, Floros
R, Schoenhaus H et-al. Juvenile fracture of tillaux. A distal tibial epiphyseal
fracture. J Am Podiatr Med Assoc. 1989;79 (6): 295-9