Tillaux-Chaput tubercle fractures or distal anterior tibial tubercle fractures are avulsion injuries affecting the tibial origin of the anterior inferior tibiofibular ligament 1-5. As a counterpart to the Tillaux fracture in adolescents, they can occur in adults in association with other ankle fractures or isolation 1-3.
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Epidemiology
An isolated Tillaux-Chaput tubercle fracture is a rare type of injury 1,2.
Associations
distal fibular fractures (Weber type B) 5
Clinical presentation
Clinical symptoms are unspecific and include acute pain, swelling and restricted motion after trauma 1,2.
Pathology
A Tillaux-Chaput avulsion fracture is an avulsion injury and is a consequence of anterior inferior tibiofibular ligament tension 1-4. The avulsed fragment often has a triangular shape 1.
Mechanism
The mechanism of this type of avulsion injury is often the result of an external rotation or abduction 3,4.
Subtypes
The following subtypes have been described 6,7:
type 1: extra-articular avulsion fracture
type 2: anterolateral tibial fracture with involvement of the articular surface and the fibular notch
type 3: impaction of the anterolateral tibial plafond
Radiographic features
A Tillaux-Chaput tubercle fracture is evident as bony discontinuity between the anterior tibial tubercle and the tibial plafond.
Plain radiograph
Standard radiographs of the ankle may not show an avulsion injury of the tibial tubercle 1.
CT
CT is often required for exact visualisation and position of the avulsed fragment in relation to the tibial plafond 1-3.
Radiology report
The radiological report should contain the following:
fracture morphology and displacement
position of the lateral malleolus in relation to the fibular notch
associated injuries
Treatment and prognosis
Management will depend on the displacement of the avulsed fragment and the associated injuries. Most avulsions will show variable displacement 3 and require closed reduction under general anaesthesia or open reduction and internal fixation, if closed reduction is unsuccessful or if associated injuries are present. Isolated avulsions without significant displacement (fracture gap <2 mm) might be managed conservatively with a non-weight bearing ankle brace or cast and an internally rotated foot 1,2.
Complications
Conservative treatment of dislocated fragments can lead to fracture non-union, malposition of the distal fibula and osteoarthritis of the ankle 6.
History and etymology
A Tillaux-Chaput tubercle injury was first described by the British Surgeon Sir Astley Cooper in 1822 1,8,9 and later by the French Surgeon Paul Jules Tillaux in 1948 10.
The French surgeon Henri Chaput described a similar injury to the posterolateral tibia in 1907 11.
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