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. 2020 Sep 17;15(1):423.
doi: 10.1186/s13018-020-01961-7.

Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome

Quanwen Yuan  1 , Zhixiong Guo  1 , Xiaodong Wang  1 , Jin Dai  1 , Fuyong Zhang  1 , Jianfeng Fang  1 , Chunhua Yin  1 , Wentao Yu  1 , Yunfang Zhen  2
Affiliations

Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome

Quanwen Yuan et al. J Orthop Surg Res. .

Abstract

Background: The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern.

Methods: The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores.

Results: The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6-8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7.

Conclusions: Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.

Keywords: Adolescents; Ankle; Mallelous; Tibia; Tillaux fracture.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
(Case 2): a AP radiograph showed Tillaux fracture, distal fibular fracture, and MMF associated with widening of the tibiofibular clear space and medial space of the ankle (black double arrow). b Axial CT section showed 8 mm displacement of Tillaux fragment and a normal incisura fibularis. c Coronal CT scan showed widening of the medial clear space of the ankle, which indicates TS. d AP plain radiograph obtained 12 months after treatment showed complete reduction of medial joint space immediately post operatively
Fig. 2
Fig. 2
(Case 6): a AP radiograph showed distal fibular fracture and MMF associated. b Lateral view showed a radiolucent zone consistent with a fracture at the posterior aspect of the tibia, but it was not clear because of superimposition of the fibula. c, d, and e Axial CT section and 3D showed Tillaux fragment and APITEL (black arrow). f General observation showed significant edema of the soft tissue. g AP plain radiograph obtained 7 months after treatment showed complete reduction of medial joint space immediately post operatively
See this image and copyright information in PMC

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