Presentation
History
Tillaux fracture is common in adolescents (age 12-15 years) and rare in adults. A history of low-velocity trauma or sporting activities with external rotation of the foot in relation to the leg is common.
Symptoms include the following:
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Severe pain over the anterior aspect of the ankle
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Inability to bear weight
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Limp (in cases of neglected injuries presenting late)
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Physical Examination
Signs of Tillaux fracture include the following:
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Swelling over the anterior aspect of the distal leg and ankle
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Presence of bruising or ecchymosis
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Possible external rotation deformity of the foot in severe injuries
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Possible tenderness over the region of the medial malleolus or the deltoid ligament if there is failure of the medial column
The lateral aspect of the leg and the entire fibula must be palpated for tenderness to exclude a high fibular fracture. Distal neurovascular status of the limb must be assessed and usually is normal. Checking for instability of the anterior tibiofibular ligament is difficult in the acute setting and must be attempted only with the patient under general anesthesia in the operating room.
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Complications
Complications due to the injury itself include the following:
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Pain or stiffness for up to 2 years after the injury
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Joint incongruity causing degenerative arthritis
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Varus deformity
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Rotational deformity (rare)
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Tibiotalar slant
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Nonunion
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Delayed union (rare)
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Leg-length inequality (extremely rare)
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Media Gallery
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Radiograph showing avulsion fracture of anterolateral tibia with widening of ankle mortise; fractured fragment appears radiopaque over distal fibula. Also note fracture of talus in this case.
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