A Tillaux fracture is a type of ankle injury that occurs almost exclusively in adolescents.
It involves a fracture through the anterolateral portion of the distal tibial epiphysis, at a time when the growth plate (physis) is starting to close. These injuries are classified as Salter-Harris type III fractures. This means they extend from the growth plate into the ankle joint surface.
During growth, the medial part of an adolescent’s growth plate fuses earlier than the lateral side. This transitional phase creates a window of vulnerability. The injury typically occurs between the ages of 12 and 15, just before skeletal maturity, and requires careful assessment due to its involvement of the weight-bearing joint surface.
Types of Tillaux Fractures and Mechanism of Injury
Tillaux fractures typically:
- Occur in adolescents during the final stages of physeal closure.
- Only the anterolateral aspect of the distal tibia is involved.
- Extend into the joint surface, affecting ankle alignment and function.
The mechanism of injury:
Tillaux fractures are commonly caused by external rotation of the foot relative to the leg. They therefore often occur during a twisting injury. The anterior inferior tibiofibular ligament (AITFL) pulls on the anterolateral epiphysis, causing it to fracture before the growth plate has fully fused. These injuries are most commonly seen during high-intensity sports, falls, or awkward landings.
Symptoms and Diagnosis of a Tillaux Fracture
Symptoms of a Tillaux fracture include:
- Pain and tenderness over the front and outside of the ankle
- Swelling and bruising
- Difficulty weight-bearing
- Decreased ankle motion, especially with twisting movements
Diagnosis
Initial imaging usually includes standard ankle X-rays in multiple views (AP, lateral, mortise), but these may underestimate the degree of joint involvement. Therefore, CT scans are often recommended, particularly to accurately assess displacement (even 2 mm of joint step-off may require surgery) and to guide treatment decisions in borderline cases.
Treatment Approaches for a Tillaux Fracture
Treatment depends on the degree of displacement:
- Non-operative treatment is suitable for fractures with <2 mm of displacement. These are typically managed with:
- A short leg cast or moon boot
- Close radiographic follow-up to confirm maintenance of alignment
- Surgical treatment (ORIF) is indicated when:
- Displacement is ≥2 mm, particularly involving the joint surface.
- The fracture cannot be aligned properly with casting alone.
- Surgery involves anatomical reduction and internal fixation with screws to restore joint congruity and prevent long-term complications like arthritis.
Prognosis for a Tillaux Fracture
Most Tillaux fractures heal well with appropriate treatment. The prognosis is excellent when the joint surface is restored and growth plate injury is addressed early. Healing typically occurs over 6–8 weeks, with a gradual return to normal activities.
Delayed or inadequate treatment may lead to:
- Joint incongruity and early arthritis
- Physeal arrest (growth plate closure), which may cause deformity if other growth centres are still open
However, because this fracture occurs close to skeletal maturity, most patients do not experience significant growth disturbances if managed appropriately.
Role of Access Ortho in Diagnosing and Treating Tillaux Fractures
Access Ortho offers rapid assessment and treatment for adolescent ankle injuries like Tillaux fractures. Our clinics are well-equipped to manage growth plate injuries, focusing on joint preservation and long-term function.
When you visit Access Ortho, you can expect:
- No-referral-required access
- Rapid appointments
- Referral for X-rays and coordination of CT imaging when needed
- Precise diagnosis and decision-making support for surgical or non-surgical care
- Moon boot or cast application at the time of diagnosis
- Ongoing non-surgical follow-up care, including repeat imaging and recovery planning
- Guidance for return to sport and school after recovery
Our team understands the importance of early, accurate treatment to ensure a full return to activity for growing adolescents.