Distal Radius Salter-Harris III Transitional Fracture in an Adolescent Male

In contrast to the well-described Tillaux fracture of the distal tibia, transitional fractures of the distal radius are exceedingly rare and have yet to be well described. Thus far, their presence in the literature has been limited to case reports and a singular series. None have involved a Salter-Harris III fracture pattern. We present the case of a 16-year-old male who sustained a Salter-Harris III transitional fracture of the distal radius with an associated ulnar styloid avulsion fracture secondary to a fall that was treated nonoperatively. Similar to the Tillaux fracture, examination of the distal radius transitional fracture should include computed tomography scan to better illustrate the pattern of injury and guide treatment.

The rare isolated adult Chaput-Tillaux fracture: two case reports and review of the literature

<p>The authors present two isolated chaput-tillaux fractures in an adult skeleton. A high level of suspicion is required to prevent diagnostic failure. Computerized tomography scan detects hidden fractures and enables a more detailed preoperative assessment of each case. Most of the cases reported in the literature are associated with other ankle lesions. This typical juvenile pattern is rare in the adults and ideal treatment is yet to be determined.</p><p><strong> </strong></p>

Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome

Background The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern. Methods The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores. Results The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6–8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7. Conclusions Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.

Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome

Background: The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis and treatment of this complex fracture pattern. Methods: The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores. Results: The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. Talar subluxation laterally with medial space widening in three, and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6-8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7. Conclusions: Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.

Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome

Background: The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis and treatment of this complex fracture pattern. Methods: The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores. Results: The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. Talar subluxation laterally with medial space widening in three, and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6-8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7. Conclusions: Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.

Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescence: management and outcome

Background The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescence commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis and treatment of this complex fracture pattern. Methods The charts and radiographs of six patients were reviewed. The functional was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores. Results The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. Talar subluxation laterally with medial space widening in three, and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6–8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7. Conclusions Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.

Isolated Triplane Fracture Of Distal Tibia In Adolescent

Introduction: Triplane fracture is a traumatic ankle fracture seen in children 10-17 years of age. Name derives from the fact that the fracture exists in the frontal, lateral, and transverse planes and considered as transitional injuries because occur during the period of distal tibial physeal closure. It results from supinationexternal rotation injury, same as tillaux fracture. Report: We presented a case of 14 years old male with right ankle pain after fall with twisted position while running. Examination revealed tenderness on his right ankle, and radiograph showed Salter-Harris IV of tibial epiphysis. CT scan was performed to determine fracture configurations. Open reduction and internal fixation was done using posterolateral approach using T buttress plate 6 holes to fix the metaphysis fracture. Subsequently anterolateral incision was done to assess epiphysis fracture however fracture site not displaced thus lag screw was abandoned. Postoperatively, the ankle was protected in a backslab for 2week; thereafter, the ankle was mobilized and subjected to progressively increasing motion. Weight bearing was allowed to resume at 6 weeks postoperatively. A normal gait had been achieved by 12 weeks postoperatively. The diagnosis of Triplane fracture poses a diagnostic challenge and often missed in healthcare centres. On standard AP and lateral radiographs, the fractures cannot be easily detected because of superimposition as radiographic sensitivity for Triplane fracture is only 50%. CT scan of the ankle is recommended if clinical findings are suggestive. The treatment of the Tillaux fragment with compression screws in the case of displacement of >2 mm which achieves anatomical reduction, rigid fixation and early mobilization gives good prognosis. [Figure: see text][Figure: see text][Figure: see text] Conclusion: Displacement of >2 mm in any plane is an indication for surgery for both triplane and tillaux fracture, to prevent persistent pain and osteoarthritis in the future. CT scan of the ankle is necessary prior to surgery. References: Crawford, Alvin H Triplane and Tillaux fracture : Journal of Pediatric Orthopaedics : June 2012 - volume 32 pg S69-S73

Adult Tillaux Fracture in Association with Volkmann and Maisonneuve Fratures: A Case Report

Tillaux fracture is known to occur in adolescents once it happens during the transition period when the medial and central physis has finished closure, but the lateral physis is still opened. The trauma mechanism is typically external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This fracture has rarely been reported in adults, especially associated with other injuries. We report a case of Tillaux fracture in an adult, associated with a Volkmann fracture and a Maisonneuve fracture, that were surgically treated with open reduction and internal fixation and had an excellent outcome. Recognizing and appropriately treating these injuries is key in the prevention of further degenerative arthritis and instability.