Editorial Open Access

Common Errors Related to the Tillaux Fracture

Abstract

Ankle injuries are very common in children and adolescents. The clinical localization of pain to the ligaments or over the distal tibial or fibular physis should be carefully evaluated. In children with an apparently sprained ankle disproportionately severe or prolonged symptoms may be due to a missed bone injury. The most commonly missed distal tibia physeal fracture in older children and adolescents is the Tillaux fracture. Radiography remains the imaging standard for the diagnosis of a Tillaux fracture. However, occasionally these injuries are quite subtle or even impossible to detect on plain radiographs. A wide variety of potential errors and pitfalls has been encountered in the description, evaluation, diagnosis and management of the Tillaux fracture in the world literature. A review of the related literature as well as two cases, misdiagnosed as ankle sprains, which represent patients of different physeal maturity and classification type, is presented in this editorial. In the former, the lesion was a Salter-Harris type III injury in a child with a completely open distal tibial physis. In the latter, the injury was a Salter-Harris type IV injury. In both cases the fracture was overlooked due to the superimposition of the fibula on the plain radiographs, although in the second patient that could also be due to a more prominent bone lesion of the distal tibial metaphysis.

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