Edited by Amy Steele and David Evans - 7/1/2021
Descriptors
Tillaux fracture, pediatric ankle fractures
Exam Pearls
SH III ankle fracture of the anterolateral distal tibia
Due to avulsion of the AITFL
Typically in children 12-14 years old, usually within 1 year of completion of closure of the physis due to the pattern of physeal closure at the distal tibia. Older than the triplane fracture cohort.
Supination-external rotation-->avulsion of the AITFL
No coronal plane fracture posteriorly
Predictable pattern of distal tibia closure over 18 months: central-->anteromedial-->posteromedial-->lateral
AITFL: anterior aspect of lateral distal tibia to the anterior aspect of the distal fibula
Workup
Radiographs: AP, lateral and mortise view of the ankle
Other imaging: CT to look for intra-articular displacement or pre-operative planning obtained AFTER any reduction and casting
Labs: None
Other: None
Management
Need for acute intervention: (choose one) Yes, usually immobilization with reduction
Weight-bearing and range of motion: NWB, no ROM
Type of immobilization: long leg cast initially to control rotation
Admission or discharge status: Generally outpatient surgery
Anticoagulation: None
Antibiotics: Only if open
Surgical Indications
Absolute: >2mm displacement after reduction