Tillaux fracture

Description

Tillaux fracture: Fracture of the anterolateral tibial epiphysis commonly seen in adolescents. (Salter-Harris III tibial fracture). See also: Wagstaffe-Le Fort Fracture – anteromedial fibula avulsion

• 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

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.

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]

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 posterolateral 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
• Eponymythology: Eponymous Foot, ankle and talus injuries. LITFL