The frontal ankle x-ray shows an translucent line through the middle of distal tibial epiphysis. The lateral ankle view shows subtle anterior protrusion of the distal tibial epiphysis.

The findings are suggestive of Tillaux fracture, Salter Harris III fracture of the distal tibia.

CT scan from the same patient:

Tillaux fracture results from external rotation forces. It is caused by avulsion injury related to anterior inferior tibiofibular ligament. The fracture involves anterolateral aspect of the distal tibial articular surface.

Our patient was managed conservatively.

Reference: Grainger & Allison’s Diagnostic Radiology E-Book.