Surgical treatment for adult ankle fracture with Tillaux-Chaput fracture block / 中国骨伤

OBJECTIVE@#To explore clinical effect of adult ankle fracture with Tillaux-Chaput fracture block.@*METHODS@#From January 2014 to December 2018, 15 patients with adult ankle fracture with Tillaux-Chaput fracture block were performed opertaion, including 9 males and 6 females, aged from 27 to 67 years old with an average of (45.6±14.3) years old, 8 patients on the left side and 7 patients on the right side. Fracture healing and complications were observed, American Orthopaedic Foot and Ankle Society(AOFAS) was used to evaluate recovery of ankle joint function.@*RESULTS@#All patients were followed up for 18 to 70 months with an average of (38.1±9.9) months. The incisions healed well at stageⅠ. X-ray reexamination showed all fractures healed well without loosening or breakage of internalfixation. Two patients had symptoms of superficial peroneal nerve injury and recovered gradually after nerve nourishing therapy. Three patients mainfested slightly limits of flexion and extension of ankle joint. AOFAS score of ankle and hind foot at the latest follow up was (85.6±7.9), 9 patients got excellent results, 4 good and 2 fair.@*CONCLUSION@#Fix Tillaux-Chaput fracture block with dentate steel plate has advantages of easy operation, stable fixation, and is beneficial to recovery of ankle function. It is not necessary to fix tibiofibular syndesmosis with screws.

Fractura de Tillaux en adultos en asociación con las fracturas de Volkmann y Maisonneuve. Reporte de caso / Adult Tillaux fracture in association with Volkmann and Maisonneuve fractures. Case report

Se sabe que la fractura de Tillaux ocurre en adolescentes una vez que ocurre durante el período de transición cuando la fisis medial y central ha finalizado el cierre, pero la fisis lateral todavía está abierta. El mecanismo de traumatismo es típicamente una lesión de tobillo de rotación externa que resulta en una fractura por avulsión del plafón tibial anterolateral. Esta fractura rara vez se ha informado en adultos, especialmente asociada con otras lesiones. Divulgamos un caso de fractura de Tillaux en un adulto, asociado con una fractura de Volkmann y una fractura de Maisonneuve, que se trataron mediante cirugía con reducción abierta y fijación interna y tuvieron un resultado excelente. Reconocer y tratar apropiadamente cada una de estas lesiones es la clave para prevenir artritis e inestabilidad degenerativas.

Tillaux fracture is known to occur in adolescents once it happens during transition period when the medial and central physis has finished closure, but the lateral physis is still opened. The trauma mechanism is typically external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This fracture has rarely been reported in adults, especially associated with others injuries. We report a case of Tillaux fracture in an adult, associated with a Volkmann fracture and a Maisonneuve fracture, that were surgery treated with open reduction and internal fixation and had an excellent outcome. Recognize and appropriately treat each one of these injuries is the key to prevent further degenerative arthritis and instability.

Adult Tillaux fracture in association with Volkmann and Maisonneuve fractures. Case report / Fractura de Tillaux en adultos en asociación con las fracturas de Volkmann y Maisonneuve. Reporte de caso

Tillaux fracture is known to occur in adolescents once it happens during transition period when the medial and central physis has finished closure, but the lateral physis is still opened. The trauma mechanism is typically external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This fracture has rarely been reported in adults, especially associated with others injuries. We report a case of Tillaux fracture in an adult, associated with a Volkmann fracture and a Maisonneuve fracture, that were surgery treated with open reduction and internal fixation and had an excellent outcome. Recognize and appropriately treat each one of these injuries is the key to prevent further degenerative arthritis and instability.

Se sabe que la fractura de Tillaux ocurre en adolescentes una vez que ocurre durante el período de transición cuando la fisis medial y central ha finalizado el cierre, pero la fisis lateral todavía está abierta. El mecanismo de traumatismo es típicamente una lesión de tobillo de rotación externa que resulta en una fractura por avulsión del plafón tibial anterolateral. Esta fractura rara vez se ha informado en adultos, especialmente asociada con otras lesiones. Divulgamos un caso de fractura de Tillaux en un adulto, asociado con una fractura de Volkmann y una fractura de Maisonneuve, que se trataron mediante cirugía con reducción abierta y fijación interna y tuvieron un resultado excelente. Reconocer y tratar apropiadamente cada una de estas lesiones es la clave para prevenir artritis e inestabilidad degenerativas.

The treatment of Tillaux bone block in the Ruedi-Allgower type Ⅲ Pilon fractures / 中国修复重建外科杂志

Objective: To analyze the importance and effectiveness of Tillaux bone block in Ruedi-Allgower type Ⅲ of Pilon fracture surgery. Method: Twenty-one patients with Pilon fractures with Tillaux dislocation were treated between February 2010 and September 2013. There were 17 males and 4 females, aged from 28 to 68 years with an average age of 42.9 years. The causes of injury included falling from height in 13 cases, falls injury in 4 cases, crush injury in 2 cases, and sprained injury in 2 cases. X-ray film and CT examination showed that all 21 patients had fibula fracture and Tillaux bone block had obvious displacement. According to AO/OTA classification, there were 3 cases of type C1.2, 1 case of type C1.3, 10 cases of type C2, and 7 cases of type C3. The duration from injury to operation ranged from 4 to 31 days, with an average of 10 days. All cases of Pilon fracture were treated with open reduction and plate internal fixation. Steel plate or screw was used to fixation for Tillaux block; allograft bone graft was selected for compression of fracture. Results: There were 2 cases of skin necrosis at the corner of wound after operation, and the wound healed after corresponding treatment; the wound healed at first intention in the other 19 cases. The effect of surgical reduction was evaluated by Burwell-Chamley imaging scoring system within 72 hours after operation, there were 19 cases of anatomical reduction and 2 cases of general reduction. All the 21 patients were followed up 18-48 months, with an average of 24.9 months. No complication such as nerve injury, loosening of internal fixation, or periprosthetic fracture was found during follow-up. All fractures obtained bone healing, which lasted from 4 to 8 months, with an average of 6 months. The ankle and hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate the ankle and hindfoot function at 1 year after operation or at last follow-up, the results were excellent in 13 cases, good in 6 cases, and fair in 2 cases, with an excellent and good rate of 90.5%. Internal fixator was removed from 19 patients at 15-19 months after operation. There were 17 cases of joint hyperplasia and 4 cases of osteoarthritis. All joint mobility was restored. The functional recovery of the ankle joint was evaluated according to the Olerud-Molander ankle fracture score standard, the results were good in 6 cases, fair in 8 cases, and poor in 7 cases at postoperative full weight training; and after 1 year of full weight training, the results were excellent in 10 cases, good in 3 cases, fair in 6 cases, and poor in 2 cases. Conclusion: The Tillaux bone block is a reliable marker for the reduction of complex Pilon fractures. The reconstruction of the Tillaux can improve the effectiveness of complex Pilon fractures.

Treatment Outcomes of Triplane and Tillaux Fractures of the Ankle in Adolescence

BACKGROUND: To identify the fracture configuration and treatment results for patients with triplane and Tillaux fractures in the ankle joint. METHODS: A retrospective study was performed on 14 patients with a more than one year follow-up. This study investigated the fracture configuration, concomitant fibula fracture, treatment methods and complications. The treatment outcomes were analyzed using modified Weber protocol. RESULTS: Among the 14 cases, 11 were triplane fractures and 3 were Tillaux fractures. Seven were two part triplane fractures, and 4 were three part triplane fractures. Eight were lateral triplane fractures, and 3 were medial triplane fractures. A fibula fracture was accompanied by 7. The fibular fracture comprised of oblique fractures in all cases. A closed and open reduction was performed in 6 and 8 cases, respectively. All but one showed excellent treatment outcomes at the final follow-up. Traumatic arthritis developed in 1 case. CONCLUSIONS: Precisely detecting the fracture configuration by computed tomography and understanding the injury mechanism have greatly improved the outcomes of triplane fractures and Tillaux fractures of the ankle in adolescent patients.

A Clinical Study of the Mechanism of Injury of Juvenile Tillaux Fracture and Triplane Fracture / 대한정형외과학회잡지

The juvenile Tillaux fracture and the triplane fracture of the distal end of the tibia in adolescents are considered uncommon injuries and the mechanism of both injuries has been uncertain. It has been postulated that both fractures probably are caused by external rotation of the foot. We atempted to evaluate the mechanism of injury as well as to conform the role of the external rotation of the foot for the juvenile Tillaux fracture and triplane fracture. From 1983 to 1988 at the department of orthopedic surgery, college of medicine, Hallym University, we evaluated the cases of nine adolescent patients with the juvenile Tillaux fracture and nine patients with the triplane fracture of the distal tibial epiphysis. We confirmed that external rotation force produced the triplane fracture as well as juvenile Tillaux fracture. And we could postulate that the triplane fracture needed further external rotation force, less closure of the distal tibial epiphysis, and more complicated mechanism of injury than the juvenile Tillaux fracture. The knowledge of these mechanism of injury enables us to use a rational manipulative approach to reduce these fractures.