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

Tillaux fracture salter harris III
Tillaux fracture. Intra-articular fracture of the anterolateral aspect of the distal tibial epiphysis

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.

Tillaux fracture salter harris III
Tillaux fracture.
Tillaux Fractures orthobullets

See also: Wagstaffe-Le Fort Fracture – anteromedial fibula avulsion

History of the Tillaux fracture

1822Astley Paston Cooper described a fracture of the lateral aspect of the distal tibia in the adult

1872Paul 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.

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.

1899Henri 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]

2013Sharma 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 Tillaux fracture Case 2
Adult Tillaux fracture: Case 1

Adult Case 2

Adult Tillaux fracture Case 12
Adult Tillaux fracture: Case 2

2019Birnie et al proposed a new AITFL avulsion fracture classification system

Birnie classification AITFL
Birnie et al 2019. Modified AITFL avulsion fracture classification system

Associated Persons

Alternative names
  • Tillaux fracture
  • Tillaux-Chaput fracture (posterolateral tibia)
  • Salter Harris type III injury of the distal tibia


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.


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the names behind the name

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. 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 |

Resident medical officer in emergency medicine MB ChB (Uni. Dundee)  MRCS Ed. Avid traveller, yoga teacher, polylinguist with a passion for discovering cultures.

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