Imaging Case of the Week 63

The following x-rays are from a 12 year old girl who sustained a right ankle injury following a fall off a skateboard. What eponymous fracture can you see?

Ankle x-ray 1

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Ankle x-ray 2

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Ankle lateral

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The AP and mortise views show a Salter-Harris Type III fracture of the anterolateral distal tibial epiphysis with moderate displacement. The lateral ankle x-ray shows ankle teardrop sign, indicating the presence of an ankle effusion. There is also soft tissue swelling around the joint.

This particular injury is called a Tillaux fracture, named after the French surgeon who first described it.

Tillaux fracture

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ankle effusion

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Tillaux fracture:

  • Occurs in the age group of 12-15 years
  • External rotation injury to the ankle causing stretching of the anterior tibiofibular ligament, which in turn avulses the anterolateral part of distal tibial epiphysis.
  • Salter-Harris III injury

All Tillaux fractures require referral to an orthopaedician from the ED; this particular patient underwent operative fixation of the fracture.