A Tillaux Fracture and Concurrent Nondisplaced Salter-Harris Type III Fracture of the Distal Fibula: A Case Report

The Salter-Harris classification system categorizes pediatric fractures in relation to the physis. A Salter-Harris type III fracture occurs from the physis extending to the epiphysis. Tillaux fractures are a type of Salter-Harris type III fracture that occurs due to incomplete fusion of the growth plate and includes the anterolateral tibial epiphysis. This specific fracture is unique to adolescents due to the anterior tibiofibular ligament's strength in relation to the growth plate, causing avulsion of the tibial fragment. The settings for a Tillaux fracture and a Salter-Harris type III fracture are uncommon due to the mechanism of injury, and it is incredibly rare to have two separate fractures of these classifications in the same ankle. In this case study, a 16-year-old male presented to the emergency department after sustaining trauma to the right ankle via a skateboarding accident. Initial radiographs showed no evidence of acute fracture, and CT imaging was performed. CT scan of the right lower leg found a Tillaux fracture of the distal right tibia with a 2 mm displacement and a nondisplaced Salter-Harris type III distal fibula fracture. Closed reduction and percutaneous screw fixation of the distal tibia fracture were performed. The repair of this fracture was complicated due to the presence of two distinct fractures. This case study aims to provide a viable option to successfully repair this complex presentation as well as explain imaging findings that differentiate this fracture from other pathologies that are not managed operatively.