Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome
- PDF / 1,048,224 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 57 Downloads / 163 Views
(2020) 15:423
RESEARCH ARTICLE
Open Access
Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome Quanwen Yuan, Zhixiong Guo, Xiaodong Wang, Jin Dai, Fuyong Zhang, Jianfeng Fang, Chunhua Yin, Wentao Yu and Yunfang Zhen*
Abstract Background: The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern. Methods: The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores. Results: The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6–8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7. Conclusions: Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability. Keywords: Adolescents, Ankle, Mallelous, Tibia, Tillaux fracture
Background Physeal injuries of the distal tibia are second in frequency to those of the distal radius and carry a high risk of complications. Tillaux fracture accounts for approximately 2.9–6.7% of the distal tibial epiphyseal fractures [1, 2]. It usually occurs in adolescents when the center and medial side of the distal tibial physis have been closed and the anterolateral quadrant fusion does not occur. The mechanism of injury involved external * Correspondence: [email protected] Children’s Hospital of Soochow University, No. 92 Zhongnan street, Suzhou, Industrial Park, Jiangsu, China
rotation of the foot contributing to the avulsion of the anterior inferior tibiofibular ligament (AITFL). The pediatric medial malleolar fractures (MMF) usually involved the growth plate, often Salter-Harris III or IV fractures, and carried the highest risk of complication for the premature physeal closure (PPC) [3–5], whereas fractures of other parts of the medial malleolus have received sporadic attention in the literature for lower rate of growth disturbance and non-weight-bearing area. However, the medial malleolus plays an important role in ankle stability as a bony restraint [6].
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution
Data Loading...
