The Tillaux fracture is a specific type of ankle fracture that occurs in adolescents during the critical period of skeletal development, typically between the ages of 11 to 16 years when the lateral aspect of the distal fibula is still actively growing. This fracture is characterized by a triplanar fracture of the lateral malleolus, which usually involves the distal fibula just above the level of the syndesmosis. The mechanism of injury is often a combination of external rotation and inversion of the ankle, which can be seen in activities such as sports, where sudden directional changes occur. The unique nature of a Tillaux fracture involves the involvement of the growth plate (physis) of the fibula, which can complicate the healing process if not diagnosed and treated promptly. Clinically, patients typically present with significant ankle pain, swelling, and tenderness in the lateral aspect of the ankle, accompanied by difficulty in weight-bearing and ambulation. Radiographic evaluation is essential for diagnosis, where X-rays will typically reveal the fracture line extending from the lateral malleolus toward the syndesmosis, often requiring additional imaging such as CT scans for a clearer delineation in complex cases. The management of a Tillaux fracture largely depends on the degree of displacement and whether the fracture is stable or unstable. Non-displaced fractures may be successfully treated through conservative management, which consists of immobilization in a cast or walking boot for several weeks, followed by gradual mobilization and rehabilitation. However, displaced fractures often necessitate surgical intervention through open reduction and internal fixation (ORIF) to restore anatomical alignment and allow for proper healing. Delay or failure to appropriately treat a Tillaux fracture can lead to complications such as malunion, non-union, or post-traumatic arthritis, given that proper alignment is crucial for maintaining normal ankle function. Attention should also be given to the potential for growth disturbances in adolescents, as improper management can affect future growth and lead to deformities. The prognosis for patients with Tillaux fractures is generally favorable when treated correctly, allowing for full recovery and return to pre-injury activity levels. However, ongoing evaluation is important as the patient grows, ensuring that any long-term consequences are monitored and addressed early. Education regarding the healing process and rehabilitation is crucial for both patients and their families to enhance recovery and maintain optimal functional results. Overall, timely recognition and appropriate treatment of the Tillaux fracture are paramount, especially in the context of a growing adolescent population, to prevent complications and promote healthy outcomes in orthopedic practice.
