Tillaux fracture

Last revised by Andrew Murphy on 26 Jul 2023

Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement.

It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse.

The fracture commonly results from an abduction-external rotation mechanism. With this mechanism, the inferior anteroinferior tibiofibular ligament avulses the anterolateral corner of the distal tibial epiphysis 3.

The fracture requires an open physis (the lateral aspect of the distal tibial physis usually closes between 12 to 15 years of age while the medial aspect closes earlier). The lateral epiphyseal involvement is due to growth plate fusion commencing from medial to lateral aspect.

Vertical fracture through the distal tibial epiphysis (Salter-Harris III) with a horizontal extension through the lateral aspect of the physis. The lack of a metaphyseal fracture component in the coronal plane (evaluated with lateral x-ray or CT) distinguishes a Tillaux fracture from a triplanar fracture.

The degree of displacement will dictate management. Operative reduction and internal fixation (ORIF) is required when the displacement is marked or unable to be corrected with closed reduction.

As with any intra-articular fracture, a persistent articular surface step predisposed the joint to premature secondary osteoarthritis.

It is named after Paul Jules Tillaux, French surgeon and anatomist (1834-1904) 2.

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Cases and figures

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