Classic history and presentation: An adolescent presents after a twisting injury to their ankle. They may have pain, swelling, ecchymosis, and inability to bear weight.
Prevalence: 3%-5% of pediatric ankle fractures are Tillaux fractures.
- Age – 12-14 years of age
- Sex / gender – more common in female children and adolescents
Pathophysiology: In children and adolescents, the stabilizing ligaments of the ankle are stronger than the physis. Therefore, in pediatric ankle trauma, the physis is most susceptible to injury. For adolescents, there is an 18-month transitional period as the distal tibia physis closes, and the lateral side closes last. Fractures can occur during this transitional period through the unfused portion of the physis. Tillaux fractures involve the anterolateral distal tibia due to avulsion of the anterior inferior tibiofibular ligament. The resulting fracture fragment corresponds to the part of the distal tibial physis that is still open. The fracture is horizontal through the open physis and then exits vertically into the ankle joint.
Grade / classification system: There is no classification system specific to Tillaux fractures, but they are considered a Salter-Harris type III fracture. The Salter-Harris classification is used to describe physeal injuries in children. Type III fractures include the physis and exit through the epiphysis into the joint. There is a classification system for pediatric ankle fractures (Dias-Tachdjian). The Tillaux fracture does not fit into the 4 main categories and has been added as an additional fracture type.