From the Research
A positive Tillaux sign indicates a fracture of the anterolateral tibial plafond, which is a rare injury in adults, and treatment depends on the severity of the fracture, with options ranging from conservative management to surgical intervention. The Tillaux fracture is an external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond, and it is essential to diagnose this injury promptly to initiate appropriate treatment 1.
Diagnosis and Treatment
The diagnosis of a Tillaux fracture can be made with standard radiological views, including antero-posterior and lateral views of the ankle, but an oblique view may be required to clearly show the fracture displacement 1. The treatment of a Tillaux fracture depends on the severity of the injury, with conservative management options including immobilization with a non-weight bearing cast or ankle braces for 6 weeks for fractures with less than 2 mm displacement 1.
- For fractures with more than 2 mm displacement, closed reduction or open reduction and internal fixation may be necessary to restore the proper alignment of the bone fragments 1.
- Anatomic reduction, rigid fixation, and early mobilization are crucial to obtain a satisfactory functional outcome, as shown by long-term follow-up findings 2.
- Early diagnosis through clinical examination and appropriate imaging, such as stress radiographs, MRI, or CT, helps determine the optimal treatment approach 3.
Importance of Proper Treatment
Proper treatment of a Tillaux fracture is essential to prevent long-term complications, such as chronic ankle instability, premature arthritis, and persistent pain 4, 5. Untreated syndesmotic injuries can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately 4.
- The goals of management are to restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis 5.
- Fixation of the syndesmosis is indicated when evidence of a diastasis is present, and this may be detected preoperatively or intraoperatively 5.