Tillaux fracture

Description

Tillaux fracture: Fracture of the anterolateral tibial epiphysis commonly seen in adolescents. (Salter-Harris III tibial 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

See also: Wagstaffe-Le Fort Fracture – anteroerolateral tibia avulsion

History

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; subsequently he observed it 42 times in 136 fractures of the ankle. [Les fractures malléolaires du cou-de-pied et les accidents du travail – 1907]

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

• 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. Volume II p856-868. 1891
• Chaput H. Les fractures malléolaires du cou-de-pied et les accidents du travail. [Malleolar instep fractures and occupational injuries] Paris, Masson 1908.
• 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.
• Lebrun A. L’appareil de Tillaux dans les fractures de la diaphyse du fémur. Bruxelles: 1880
• Dias LS, Giegerich CR. Fractures of the distal tibial epiphysis in adolescence. J Bone Joint Surg Am. 1983; 65(4): 438-44.
• Kumar N, Prasad M. Tillaux fracture of the ankle in an adult: a rare injury. J Foot Ankle Surg. 2014; 53(6): 757-8.
• Sharma B, Reddy IS, Meanock C. The adult Tillaux fracture: one not to miss. BMJ Case Rep. 2013;
• 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.
• Eponymythology: Eponymous Foot, ankle and talus injuries. LITFL