Tillaux Fracture in Adults. Case Report and Literature Review
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Published:
Feb 17, 2023
Keywords:
Adult, fracture fixation, Tillaux fracture, ankle
Main Article Content
Abstract
Introduction: The fracture of the anterolateral region of the distal tibial epiphysis, or Tillaux-Chaput tubercle, is known as Tillaux fracture. It is an exceptional entity in adults, but it has significant importance because it affects the tibiotalar joint surface, the stability of the syndesmosis, and, in some cases, the fibular notch. We present the case of a 45-year-old woman treated in the Emergency Service due to rotational trauma to the left ankle and functional impairment and pain in the anterolateral region of the ankle. The radiographs led to the suspicion of a fracture line corresponding to the Tillaux-Chaput tubercle. Therefore, a CT scan was performed, which confirmed a Tillaux fracture with a >2 mm displacement and involvement of the fibular notch. The patient underwent open reduction and internal fixation. The fracture consolidated after 3 months. One year after surgery, her clinical and functional status was excellent. Conclusion: Diagnostic suspicion through meticulous physical examination and anamnesis and confirmation by imaging studies are essential for the proper management of rare fracture patterns, such as Tillaux fractures.
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How to Cite
Pérez Abdala, J. I., Carabelli, G., De Cicco, F. L., Sancineto, C. F., Barla, J. D., & Taype Zamboni, D. (2023). Tillaux Fracture in Adults. Case Report and Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(1), 107-112. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1657
Section
Case Presentations
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References
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[published correction appears in Orthop Traumatol Surg Res. 2022 Apr;108(2):103237]. Orthop Traumatol Surg
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5. Ali Al-Ashhab ME, Mahmoud Mohamed AA. Treatment for displaced Tillaux fractures in adolescent age group.
Foot Ankle Surg 2020;26(3):295-8. https://doi.org/10.1016/j.fas.2019.04.001
6. Feng SM, Sun QQ, Wang AG, Li CK. “All-Inside” arthroscopic treatment of Tillaux-Chaput fractures: Clinical
experience and outcomes analysis. J Foot Ankle Surg 2018;57(1):56-9. https://doi.org/10.1053/j.jfas.2017.07.020
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https://doi.org/10.1053/j.jfas.2014.06.010
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2013;2013:bcr2013200105. https://doi.org/10.1136/bcr-2013-200105
9. Oak NR, Sabb BJ, Kadakia AR, Irwin TA. Isolated adult Tillaux fracture: a report of two cases. J Foot Ankle Surg
2014;53(4):489-92. https://doi.org/10.1053/j.jfas.2014.03.012
10. Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, et al. Articular fractures: does an anatomic
reduction really change the result? J Bone Joint Surg Am 2002;84(7):1259-71. PMID: 12107331
11. Crawford AH. Triplane and Tillaux fractures: is a 2 mm residual gap acceptable? J Pediatr Orthop 2012;32Suppl 1:S69-S73. https://doi.org/10.1097/BPO.0b013e31824b25a1
12. Sferopoulos N. Common errors related to the Tillaux fracture. Res Rev Orthop 2018;2(2):10-3. Disponible en:
https://www.researchgate.net/publication/330244587_Common_Errors_Related_to_the_Tillaux_Fracture
13. Millán-Billi A, Fa-Binefa M, Gómez-Masdeu M, Carrera I, De Caso J. Tillaux fracture in adults - Case report and
review of literature. J Clin Orthop Trauma 2022;27:101809. https://doi.org/10.1016/j.jcot.2022.101809
14. Lampridis V, Gougoulias N, Sakellariou A. Stability in ankle fractures: Diagnosis and treatment. EFORT Open Rev 2018;3(5):294-303. https://doi.org/10.1302/2058-5241.3.170057
15. Birnie MFN, van Schilt KLJ, Sanders FRK, Kloen P, Schepers T. Anterior inferior tibiofibular ligament avulsion
fractures in operatively treated ankle fractures: a retrospective analysis. Arch Orthop Trauma Surg 2019;139(6):787-93. https://doi.org/10.1007/s00402-019-03138-2
16. Gómez JT, Torrent Gómez J, Castillón Bernal P, Anglès Crespo F. Fractura de Tillaux del adulto: a propósito de un caso. Revista del Pie y Tobillo 2012;26:43-6. https://doi.org/10.1016/S1697-2198(16)30056-8
17. Horn BD, Crisci K, Krug M, Pizzutillo PD, MacEwen GD. Radiologic evaluation of juvenile tillaux fractures of the
distal tibia. J Pediatr Orthop 2001;21(2):162-4. https://doi.org/10.1097/01241398-200103000-00005
https://doi.org/10.5435/JAAOS-21-04-234
2. Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am
2012;94(13):1234-44. https://doi.org/10.2106/JBJS.K.00682
3. Tourné Y, Molinier F, Andrieu M, Porta J, Barbier G. Diagnosis and treatment of tibiofibular syndesmosis lesions
[published correction appears in Orthop Traumatol Surg Res. 2022 Apr;108(2):103237]. Orthop Traumatol Surg
Res 2019;105(8S):S275-S286. https://doi.org/10.1016/j.otsr.2019.09.014
4. Rammelt S, Bartoníček J, Kroker L. Pathoanatomy of the anterolateral tibial fragment in ankle fractures. J Bone
Joint Surg Am 2022;104(4):353-63. https://doi.org/10.2106/JBJS.21.00167
5. Ali Al-Ashhab ME, Mahmoud Mohamed AA. Treatment for displaced Tillaux fractures in adolescent age group.
Foot Ankle Surg 2020;26(3):295-8. https://doi.org/10.1016/j.fas.2019.04.001
6. Feng SM, Sun QQ, Wang AG, Li CK. “All-Inside” arthroscopic treatment of Tillaux-Chaput fractures: Clinical
experience and outcomes analysis. J Foot Ankle Surg 2018;57(1):56-9. https://doi.org/10.1053/j.jfas.2017.07.020
7. Kumar N, Prasad M. Tillaux fracture of the ankle in an adult: a rare injury. J Foot Ankle Surg 2014;53(6):757-8.
https://doi.org/10.1053/j.jfas.2014.06.010
8. Sharma B, Reddy IS, Meanock C. The adult Tillaux fracture: one not to miss. BMJ Case Rep
2013;2013:bcr2013200105. https://doi.org/10.1136/bcr-2013-200105
9. Oak NR, Sabb BJ, Kadakia AR, Irwin TA. Isolated adult Tillaux fracture: a report of two cases. J Foot Ankle Surg
2014;53(4):489-92. https://doi.org/10.1053/j.jfas.2014.03.012
10. Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, et al. Articular fractures: does an anatomic
reduction really change the result? J Bone Joint Surg Am 2002;84(7):1259-71. PMID: 12107331
11. Crawford AH. Triplane and Tillaux fractures: is a 2 mm residual gap acceptable? J Pediatr Orthop 2012;32Suppl 1:S69-S73. https://doi.org/10.1097/BPO.0b013e31824b25a1
12. Sferopoulos N. Common errors related to the Tillaux fracture. Res Rev Orthop 2018;2(2):10-3. Disponible en:
https://www.researchgate.net/publication/330244587_Common_Errors_Related_to_the_Tillaux_Fracture
13. Millán-Billi A, Fa-Binefa M, Gómez-Masdeu M, Carrera I, De Caso J. Tillaux fracture in adults - Case report and
review of literature. J Clin Orthop Trauma 2022;27:101809. https://doi.org/10.1016/j.jcot.2022.101809
14. Lampridis V, Gougoulias N, Sakellariou A. Stability in ankle fractures: Diagnosis and treatment. EFORT Open Rev 2018;3(5):294-303. https://doi.org/10.1302/2058-5241.3.170057
15. Birnie MFN, van Schilt KLJ, Sanders FRK, Kloen P, Schepers T. Anterior inferior tibiofibular ligament avulsion
fractures in operatively treated ankle fractures: a retrospective analysis. Arch Orthop Trauma Surg 2019;139(6):787-93. https://doi.org/10.1007/s00402-019-03138-2
16. Gómez JT, Torrent Gómez J, Castillón Bernal P, Anglès Crespo F. Fractura de Tillaux del adulto: a propósito de un caso. Revista del Pie y Tobillo 2012;26:43-6. https://doi.org/10.1016/S1697-2198(16)30056-8
17. Horn BD, Crisci K, Krug M, Pizzutillo PD, MacEwen GD. Radiologic evaluation of juvenile tillaux fractures of the
distal tibia. J Pediatr Orthop 2001;21(2):162-4. https://doi.org/10.1097/01241398-200103000-00005