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Tillaux Fracture of the Ankle in an Adult: A Rare

Injury

Article in The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle
Surgeons August 2014
DOI: 10.1053/j.jfas.2014.06.010 Source: PubMed

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 The Journal of Foot & Ankle Surgery 53 (2014) 757758

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The Journal of Foot & Ankle Surgery

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Tillaux Fracture of the Ankle in an Adult: A Rare Injury

Narinder Kumar, MBBS, MS (Ortho) 1, Manish Prasad, MBBS 2
1
Classied Specialist, Department of Orthopaedics, Base Hospital Delhi Cantt, New Delhi, India
2
Resident, Department of Orthopaedics, Base Hospital Delhi Cantt, New Delhi, India

a r t i c l e i n f o a b s t r a c t

Level of Clinical Evidence: 4 The Tillaux fracture of the ankle is an external rotation ankle injury resulting in an avulsion fracture of the
anterolateral tibial plafond. This injury is known to occur in adolescents, although it has rarely been reported
Keywords:
ankle in adults. We report a case of a Tillaux fracture in an adult. A brief description of the history, mechanism of
bula injury, required imaging, and treatment and other management options are provided in the present report.
injury Anatomic reduction, rigid xation, and early mobilization are emphasized to obtain a satisfactory functional
leg outcome, shown by the long-term follow-up ndings.
tibial plafond 2014 by the American College of Foot and Ankle Surgeons. All rights reserved.

Tillaux fractures have been described as uncommon ankle injuries in a plaster splint for 1 week; thereafter, the ankle was mobilized and
in adolescents and have rarely been reported in adults (13). These subjected to progressively increasing motion. Weightbearing was
fractures are caused by external rotational injury resulting in avulsion allowed to resume at 8 weeks postoperatively. A normal gait had been
of the anterolateral tibial plafond owing to a taut anteroinferior achieved by 12 weeks postoperatively. Follow-up examinations
tibiobular ligament. In the present report, we describe the case of a continued until 14 months postoperatively. At the nal follow-up
Tillaux fracture in an adult. We believe the rarity of this injury in visit, the clinical and radiographic assessments revealed the fracture
adults is worthy of discussion. to be well consolidated without any complications (Fig. 3). Also, the
patient was asymptomatic, with no pain or restriction of ankle
movement.
Case Report
Discussion
A 28-year-old male presented with injury to his right ankle after a
fall from a height. He had no other associated injury or history of any
The Tillaux fracture was rst described in 1822 by Sir Astley
other ankle injury. The clinical examination revealed a tender right
Cooper, and Paul Tillaux described the mechanism of this injury as
ankle with swelling localized anteriorly and anterolaterally and
painful restriction of ankle movement. Radiographs of the right ankle
revealed an avulsion fracture of the anterolateral lip of the tibial
plafond (Fig. 1). The anterolateral fragment was intra-articular, dis-
placed, and of a clinically signicant size. Computed tomography
scans were obtained to exclude the presence of a pilon fracture. The
scans conrmed the presence of a displaced Tillaux fracture, the
pattern of which was consistent with that typically associated with
the adolescent form of this injury (Fig. 2).
The patient underwent open reduction and internal xation
through an anterolateral approach, using two 3.5-mm lag screws.
During surgery, Kirschner wires were used as joysticks to help in
reducing the small fragment. Postoperatively, the ankle was protected

Financial Disclosure: None reported.

Conict of Interest: None reported.
Address correspondence to: Narinder Kumar, MBBS, MS (Ortho), Department of
Orthopaedics, Base Hospital Delhi Cantt, New Delhi 110010 India.
E-mail address: kumarnarinder1969@gmail.com (N. Kumar). Fig. 1. Standard radiograph of ankle showing Tillaux fracture.

1067-2516/$ - see front matter 2014 by the American College of Foot and Ankle Surgeons. All rights reserved.
http://dx.doi.org/10.1053/j.jfas.2014.06.010
758 N. Kumar, M. Prasad / The Journal of Foot & Ankle Surgery 53 (2014) 757758
Fig. 2. Preoperative computed tomography scan showing Tillaux fracture.
external rotation of ankle that leads to an avulsion fracture of the
anterolateral aspect of the tibial plafond owing to the pull of a taut
anteroinferior tibiobular ligament (4,5). In adults, the ligament will
usually gives way before avulsion of its attachment to the antero-
lateral tibial plafond occurs, leading to relative rarity of this avulsion
fracture injury pattern in adults. The injury can occasionally be missed
by a cursory examination of the radiographs. However, the fracture
pattern must be clearly dened preoperatively. Computed tomogra-
phy can be a useful adjunct to conrm the diagnosis, clearly dene the
extent of the fracture, and rule out any associated injuries involving
the tibial pilon (6). These fractures are usually displaced and will
require closed or open reduction with internal xation to restore
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Fig. 3. Postoperative follow-up radiograph of the ankle at 1 year showing consolidated
fracture with xation in situ.
ankle joint congruity. We believe the anterolateral approach provides
the best access to the fracture. Kirschner wires can be used as joy-
sticks to achieve accurate reduction and xation, and 1 or 2 inter-
fragmental compression screws will usually be enough to stabilize the
fractured fragment. Because it is an intra-articular fracture, congruous
reduction, rigid xation, and early mobilization are essential to ensure
a better functional outcome. Arthroscopy-assisted reduction and
percutaneous xation techniques have also been described to treat
this injury, predominantly among adolescents (7).
In conclusion, we have described a Tillaux fracture in an adult, an
unusual injury in the skeletally mature ankle.
References
1. Marti CB, Kolker DM, Gautier E. Isolated adult Tillaux fracture: a case report. Am J
Orthop 34:337339, 2005.
2. Chokkalingam S, Roy S. Adult Tillaux fractures of ankle: case report. Internet J
Orthop Surg 6(1), 2007.
3. Oak NR, Sabb BJ, Kadakia AR, Irwin TA. Isolated adult Tillaux fracture: a report of
two cases. J Foot Ankle Surg 53:489492, 2014.
4. Tillaux P. Trait de chirugie clinique. Vol 2. Paris, Asselin and Hourzeau, 1848.
5. Cooper AP. On dislocation of the ankle joints. In: A Treatise on Dislocations and on
Fractures of the joints. London, Longman, Hurst, Reese, Orme and Brown. E Cox and
Son, 1822.
6. Horn BD, Crisci K, Krug M, Pizzutillo PD, MacEwen GD. Radiologic evaluation of
juvenile Tillaux fractures of the distal tibia. J Paediatric Orthop 21:162164, 2001.
7. Miller MD. Arthroscopically assisted reduction and xation of an adult Tillaux
fracture of the ankle. Arthroscopy 13:117119, 1997.