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A Displaced and Entrapped Anterior Malleolus (Tillaux Fragment) Causing an Irreducible Syndesmosis and Ankle
Ameya H Velankar1, Sampat Dumbre Patil2, Vaishali Dumbre Patil3
1Department of Orthopaedics, MGM Institute of Health Sciences, Navi-Mumbai, Maharashtra, India.
Introduction:
Tillaux fractures are Salter-Harris type III injuries of the anterolateral distal tibial epiphysis seen in adolescents. Entrapment of the Tillaux fragment within the syndesmosis is rare and may lead to an irreducible ankle fracture-dislocation.
Case Report:
A 13-year-old girl sustained an ankle fracture-dislocation following an external rotation injury. Imaging revealed a displaced Tillaux fracture with an associated posterior malleolus fracture. Closed reduction was unsuccessful. Open reduction revealed incarceration of the Tillaux fragment within the syndesmosis, preventing reduction of the talus. Removal and anatomical fixation of anterior and posterior malleolar fragments restored syndesmotic stability. The patient achieved full functional recovery.
Conclusion:
In adolescents, failure of closed reduction of ankle fracture-dislocation should raise a suspicion of an entrapped Tillaux fragment. Computed tomography evaluation and anatomical fixation are essential for restoring joint congruency and preventing long-term complications.
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