Ankle fracture: the Tillaux fracture

Understanding the Tillaux fracture

The Tillaux fracture is a fracture that mainly affects adolescents, but it can also occur in adults either in isolation or in association with other ankle injuries. In children, this fracture involves the growth plates, which are still open and responsible for the growth of the tibia at the ankle. It is therefore important to detect this fracture in children and to stabilize it if necessary to limit the risk of growth disturbances in the tibia at the ankle, which can lead to residual deformities of the ankle.

In adults, the Tillaux fracture should be looked for in any malleolar fracture, especially of the lateral malleolus, as it may go unnoticed. It corresponds to injury of the anterior ligament bundle of the syndesmosis, known as the anterior tibiofibular ligament.

Causes and mechanisms of Tillaux fracture

The main causes of Tillaux fracture are:

• Direct trauma, often related to sporting activities or falls.
• Indirect trauma involving violent twisting movements, which are commonly seen in sports such as football or basketball.

At-risk populations

This fracture mainly concerns:

• Adolescents, due to their active bone growth and the fragility of their joints.
• Athletes, who are more exposed to injuries because of the physical demands of their sport.

This fracture should be looked for on its own or in association with other ankle fractures in adults.

Mechanisms of a Tillaux fracture

Injuries generally occur when the ankle twists while the foot remains fixed on the ground, which subjects the growth plate and the anterior tibiofibular ligament to excessive forces. The main injury mechanism is the external rotation of the ankle in forced hyper-dorsiflexion.

Symptoms of Tillaux fracture

The Tillaux fracture often appears with several distinct symptoms that can vary depending on the fracture. Recognizing these signs is important to ensure prompt and effective care. Here are the most common symptoms:

• Severe pain at the ankle, which usually worsens with movement or pressure.
• Swelling and bruising around the affected area, indicating significant inflammation.
• Difficulty walking or bearing weight on the injured limb.
• Increased tenderness when palpated, especially on the outer side of the ankle inside the lateral malleolus.

If it is impossible to bear weight again after an ankle injury, it is necessary to rule out or confirm an ankle fracture, in particular a Tillaux fracture in children and adolescents. For this, it is important to seek prompt care in an appropriate facility—pediatric for children and adolescents—for a clinical assessment and an X-ray, or even an ultrasound for the youngest, to analyze the growth cartilage and clarify the fracture lines.

Diagnosis of Tillaux fracture

Tillaux fracture diagnosis relies on several complementary methods that help confirm the fracture and determine its characteristics:

• Clinical examination: The doctor begins with a thorough physical examination. They look for signs such as pain, swelling, and limited ankle movement. Palpation of the Tillaux tubercle causes sharp pain.
• Medical imaging:
  • X-rays: These are often the first tests performed to visualize the fracture. Images taken from various angles allow for a more precise analysis of bone lesions.
  • Ultrasound: Mainly used in pediatrics, it enables analysis of the bone's nourishing membrane, the periosteum, as well as growth plates and cortical bones.
  • MRI or CT scan: These imaging techniques may be necessary to examine associated injuries: muscular, tendon, ligament, bone, and cartilage.

These steps help establish an accurate diagnosis and select the most appropriate treatment to reduce the risk of growth disorders in children and ankle instability.

Treatment of Tillaux fracture

The treatment of Tillaux fracture depends on the characteristics of the fracture, such as the size of the fracture fragment, the displacement of the fracture, the presence of a joint line, the existence of growth cartilage, and the presence of associated injuries. There are mainly two approaches: orthopedic treatment and surgical treatment.

Orthopedic treatment of a Tillaux fracture

For Tillaux fractures that are stable and non-displaced, orthopedic treatment is recommended. Here are the key points to remember:

• Immobilization: The lower limb is generally immobilized with a splint or a cast to prevent any displacement of the fracture.
• Pain management: Analgesics are often prescribed to relieve the pain and discomfort caused by the fracture.
• Rehabilitation: Once the immobilization period is over, physiotherapy exercises are recommended to regain mobility and strengthen the muscles around the ankle.

Surgical treatment of Tillaux fractures

Surgical orthopedic treatment aims to realign the bones by reducing the fracture and to stabilize the fracture with hardware and fixation adapted to the patient's age. Here is what this generally involves:

• Open reduction and internal fixation: This method consists of repositioning the bone fragments in their correct position and holding them in place with screws or plates.
• Reduction by external maneuvers and percutaneous fixation: This method consists of repositioning the bone fragments in their correct position without making an incision and holding them in place with screws introduced percutaneously.
• Reduction under arthroscopic control: The reduction of the fracture and checking the stability after fixation is possible with this technique.
• Post-operative follow-up: After the operation, regular follow-up is important to ensure bone healing and the absence of secondary displacement of the fracture.
• Rehabilitation: Post-surgical physiotherapy plays a key role in facilitating the return to daily and sporting activities. A tailor-made program will help strengthen the muscles and improve the mobility and stability of the ankle.

Recovery after Tillaux fracture

Recovery after a Tillaux fracture is important in adults. Depending on the severity of the fracture and the treatments received, rehabilitation can last from a few weeks to several months.

Here are some key steps to help you recover well:

• Rest and immobilization: After your fracture, it is important to keep your limb at rest to promote healing.
• Physiotherapy: Physiotherapy plays a central role in your rehabilitation. Targeted exercises can really help regain mobility and strength in your ankle.
• Pain management: Your doctor may prescribe medication to ease pain and discomfort during this period.
• Medical follow-up: Remember to attend regular check-ups with your doctor or physiotherapist to monitor your progress and adjust treatment if necessary.
• Adapted physical activities: Once you have received the go-ahead from your doctor, gradually resume your physical activities. Start with gentle exercises to avoid putting too much pressure on your ankle at first.

By following these tips throughout your recovery process, you will increase your chances of regaining full function in your ankle. Each step is important in your rehabilitation after a Tillaux fracture.