Tillaux fracture
Description
Tillaux fracture: Fracture of the anterolateral tibial epiphysis commonly seen in adolescents. [aka Salter-Harris III tibial fracture; Tillaux-Chaput fracture].
Usually associated with forced lateral rotation of the foot or medial rotation of the leg on a fixed foot. This rotational injury results in avulsion of the anterior tibiofibular ligament at the lateral epiphysis.
Often misdiagnosed as a simple sprain in adolescents
Usually seen on conventional AP, lateral, and mortise ankle XR. However, CT scan has better sensitivity in diagnosing Tillaux fractures and used to detect fracture displacement of >2mm – often an indication for open reduction.
Treatment is closed reduction and casting if < 2mm displacement or operative management if > 2mm displacement.
See also: Wagstaffe-Le Fort Fracture – anteromedial fibula avulsion
History of the Tillaux fracture
1822 – Astley Paston Cooper described a fracture of the lateral aspect of the distal tibia in the adult
1872 – Paul Jules Tillaux performed experiments on cadavers and found that stress to the anterior inferior tibiofibular ligament could lead to an avulsion fracture. Tillaux never clinically described the fracture.
Original
English
On comprend à tort sous le nom de fractures du péroné un certain nombre de désordres résultant d’un mouvement anormal du pied, qui peuvent porter sur la malléole externe, sur la malléole interne et sur le corps du tibia lui-même.
Les fractures malléolaires se produisent presque toujours dans un mouvement d’adduction ou d’abduction du pied, mouvement qui ne saurait exister sans un certain degré de projection de la pointe du pied en dedans ou en dehors;
Le mouvement d’adduction forcée peut produire:
- A. L’arrachement de la malléole externe seule;
- B. Cet arrachement avec éclatement de la malléole interne;
- C. Ce même arrachement avec fracture sus-malléolaire transversale du tibia.
Disorders of the ankle result from abnormal movement of the foot, which may affect the lateral malleolus, the medial malleolus and the body of the tibia itself. They are wrongly grouped as fibula fractures.
Malleolar fractures almost always occur following forced adduction or abduction of the foot, a movement which could not exist without a certain degree of projection of the tip of the foot inwards or outwards;
The forced adduction movement can produce:
- A. Tearing of the lateral malleolus alone;
- B. This tearing with fracture of the medial malleolus;
- C. This same wrenching with transverse median submalleolar fracture of the tibia.
1899 – Henri Chaput was the first to demonstrate a roentgenogram of a fracture in the dorsal lip of the tibia. He suggested that it was frequently observed as a complication of malleolar fractures. [Les fractures malléolaires du cou-de-pied et les accidents du travail – 1907]. He subsequently he observed it 42 times in 136 fractures of the ankle. [De la reduction des fractures malléolaires compliquées de luxation du pied – 1913]
2013 – Sharma et al drew attention to the rarer Tillaux fracture in adults, as opposed to the more common juvenile Tillaux fracture in adolescents; the avulsed fragment is usually triangular in adults and quadrangular in juvenile Tillaux fracture
Adult Case 1
Adult Case 2
2019 – Birnie et al proposed a new AITFL avulsion fracture classification system
Associated Persons
- Paul Jules Tillaux (1834 – 1904)
- Henri Victor Chaput (1857 – 1919)
- Astley Paston Cooper (1768 – 1841)
Alternative names
- Tillaux fracture
- Tillaux-Chaput fracture (posterolateral tibia)
- Salter Harris type III injury of the distal tibia
Controversies
A similar injury to the anterolateral tibia cadeveric description by Tillaux (1872) was later described by Henri Chaput in 1907 hence the term the Tillaux-Chaput fracture.
References
Original articles
- Cooper AP. On dislocation of the ankle joints. In: A treatise on dislocations and on fractures of the joints. London, 1822
- Tillaux PJ. Recherches cliniques et expérimentales sur les fractures malléolaires. [Reported by Gosselin]. Bulletin de l’Academie de médecine. 1872; 21: 817-826
- Tillaux PJ. Traité de chirurgie clinique. 1891; II: 856-868
- Chaput H. Les fractures malléolaires du cou-de-pied et les accidents du travail. [Malleolar instep fractures and occupational injuries] Paris, Masson 1907.
- Chaput H. De la reduction des fractures malléolaires compliquées de luxation du pied. Bulletins et Mémoires de la Société de Chirurgie de Paris. 1913; 39: 656-663
Eponym reviews
- Dias LS, Giegerich CR. Fractures of the distal tibial epiphysis in adolescence. J Bone Joint Surg Am. 1983; 65(4): 438-44.
- von Laer L. Classification, diagnosis, and treatment of transitional fractures of the distal part of the tibia. J Bone Joint Surg Am. 1985 Jun;67(5):687-98.
- Hasler C, Hardegger F. Fracture of the Tillaux-Chaput tubercle–a case from pediatric traumatology. Z Unfallchir Versicherungsmed. 1993; 86(3): 149–51
- Koury SI, Stone CK, Harrell G, La Charité DD. Recognition and management of Tillaux fractures in adolescents. Pediatr Emerg Care. 1999; 15(1): 37-9.
- Duchesneau S, Fallat LM. The Tillaux fracture. J Foot Ankle Surg. 1996; 35(2): 127-33; discussion 189.
- Horn BD, Crisci K, Krug M, Pizzutillo PD, MacEwen GD. Radiologic evaluation of juvenile tillaux fractures of the distal tibia. J Pediatr Orthop. 2001 Mar-Apr;21(2):162-4.
- Rosenbaum AJ, DiPreta JA, Uhl RL. Review of distal tibial epiphyseal transitional fractures. Orthopedics. 2012; 35(12): 1046-9.
- Sharma B, Reddy IS, Meanock C. The adult Tillaux fracture: one not to miss. BMJ Case Rep. 2013;
- Narinder K, Prasad M. Tillaux Fracture of the Ankle in an Adult: A Rare Injury. J Foot Ankle Surg 2014; 53 (6), 757-8
- Zhao J et al. [Clinical features and surgical effectiveness of ankle fractures involving Tillaux-Chaput in adults]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Mar;29(3):288-91.
- Kose O et al. Isolated Adult Tillaux Fracture Associated With Volkmann Fracture—A Unique Combination of Injuries: Report of Two Cases and Review of the Literature. J Foot Ankle Surg. 2016; 55(5): 1057-62.
- Mishra PK et al. Chaput Tubercle Fracture in an Adult- A Rare Case Report. J Clin Diagn Res. 2017 Mar; 11(3): RD01–RD02.
- Tak S, Qureshi MK, Ackland JA, Arshad R, Salim J. Adolescent Tillaux Fractures: A Systematic Review of the Literature. Cureus. 2021 Jan 22;13(1):e12860
- Botz B. Tillaux fracture Case. Radiopaedia
- Hacking C. Tillaux fracture. Radiopaedia
- McKennedy C. Tillaux fracture – Eponym A Day. Instagram
- Eponymythology: Eponymous Foot, ankle and talus injuries. LITFL
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BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Associate Professor Curtin Medical School, Curtin University. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |
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