Tillaux Fracture of The Distal Tibia (Salter-Harris Type III) In an Adolescent: A Case Report

Abstract

A Salter-Harris Type III fracture represents a rare intra-articular growth plate injury in pediatric patients, characterized by a fracture line that traverses the physis and extends into the epiphysis, reaching the articular surface. A Tillaux fracture is a specific variant of this injury, occurring due to incomplete closure of the distal tibial growth plate and involving the anterolateral tibial epiphysis. This fracture pattern is unique to adolescents, as the relative strength of the anterior tibiofibular ligament compared to the partially fused physis predisposes the tibial fragment to avulsion. In the present case, a 13-year-old female presented to the emergency department following a twisting mechanism of injury to the left ankle. Initial plain radiographs (X-rays) demonstrated findings consistent with an acute, undisplaced Salter-Harris Type III fracture. Subsequent CT imaging of the left lower leg confirmed a Tillaux fracture of the distal tibia with approximately 2 mm displacement, which had been subtly overlooked on the initial radiographs. Management included closed reduction followed by percutaneous screw fixation, resulting in satisfactory stabilization of the fracture. This case highlights the importance of advanced imaging modalities, particularly CT scans, in differentiating Tillaux fractures from other ankle pathologies that may not require operative intervention. It also underscores the need for accurate diagnosis and timely surgical management to optimize outcomes in adolescent patients with transitional growth plate injuries.