Tillaux Fracture (Ankle)

Description

A Tillaux fracture is an ankle fracture in which a ligament pulls off the front-outer corner of the lower shin, through the last part of the growth plate that has not yet closed. Like the triplane fracture, it occurs in older adolescents during the window when the ankle growth plate is sealing.

How it happens (the mechanism)

The ankle’s growth plate does not close all at once — it seals from the inside (medial) toward the outside (lateral) over roughly a year and a half. That leaves the front-outer (anterolateral) corner as the last part still open and vulnerable. When the ankle twists, a strong ligament attached to that corner pulls it off along the still-open growth plate — the adolescent version of what would simply be a sprain in a fully grown adult.

What makes this fracture matter is that it runs into the joint surface. The concern is not instability but joint congruity — keeping the gliding surface of the ankle smooth and even — because that is what protects comfortable, durable ankle motion for the decades ahead.

Symptoms

Pain, swelling, and tenderness at the front-outer ankle after a twist, with difficulty bearing weight.

Doctor examination and imaging

The doctor examines the ankle; X-rays show the fracture, and a CT scan is often used to judge the joint-surface alignment precisely before deciding on treatment.

Nonsurgical treatment

When the joint surface is well-aligned (the gap and step-off are small, generally within a couple of millimeters), the fracture is treated in a cast.

Surgical treatment

When the corner is displaced, it is realigned to restore the joint surface, usually held with a single screw through a small incision.

Recovery and long-term outlook

Because it happens near the end of growth, future growth is generally not a concern; restoring a smooth joint surface is what gives the ankle a healthy long-term result.

When to call the doctor

Call the office right away if your child’s toes become numb, pale, blue, or cold; pain keeps worsening even after raising the leg and giving medicine; swelling does not improve with elevation; the cast feels too tight, cracked, or wet, or smells bad; or your child develops a fever.

Learn more

OrthoInfo (AAOS) — Growth Plate Fractures: orthoinfo.aaos.org

This information is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. For specific concerns about your child, consult a board-certified, fellowship-trained pediatric orthopaedic surgeon.