CLINICAL FEATURES AND SURGICAL EFFECTIVENESS OF ANKLE FRACTURES INVOLVING Tillaux-Chaput IN ADULTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAOJinwei ^1,2 ,  SHUHengsheng ² , LIWeizhe ² , LIUYabin ² , SHIBowen ² , ZHENGGuotao ^1,2

1. Graduate College of Tianjin Medical University, Tianjin, 300070, P. R. China;
2. Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, 300070, P. R. China;

Corresponding author：

SHUHengsheng, Email: drhsshu@hotmail.com

Keywords：

Ankle fracture; Tillaux-Chaput fracture; Open reduction and internal fixation

DOI：

10.7507/1002-1892.20150062

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Objective To investigate the clinical features of ankle fractures involving Tillaux-Chaput in adults, and to observe the surgical effectiveness. Methods Between May 2009 and May 2013, 15 adult patients with ankle fractures involving Tillaux-Chaput were treated by open reduction and internal fixation. There were 12 males and 3 females, with an average age of 32 years (range, 19-45 years). The causes included sport injury (8 cases), traffic accident injury (5 cases), and falling injury from height (2 cases). The left ankle was involved in 5 cases and the right side in 10 cases. There were 2 open fractures (Gustilo type I) and 13 close fractures. Five patients had single Tillaux-Chaput fractures. The mean time between injury and surgery was 8.5 days (range, 3 hours to 15 days). According to the Lauge-Hansen classification, there were 9 cases of supination-external rotation, 5 cases of pronation-external rotation, and 1 case of pronation-abduction. Results Primary healing of incisions was obtained in 13 patients without infection and neurovascular injury; 2 patients had superficial infection which was cured after oral antibiotics and dressing change. All cases were followed up for 23 months on average (range, 13-36 months). X-ray films showed complete fracture healing at 10-16 weeks postoperatively (mean, 13 weeks) in all cases. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 87 (range, 78-99), with an excellent and good rate of 80% (excellent in 9 cases, good in 3 cases, and fair in 3 cases). Conclusion Open reduction and internal fixation for ankle fractures involving Tillaux-Chaput in adults can achieve excellent effectiveness.

Citation： ZHAOJinwei, SHUHengsheng, LIWeizhe, LIUYabin, SHIBowen, ZHENGGuotao. CLINICAL FEATURES AND SURGICAL EFFECTIVENESS OF ANKLE FRACTURES INVOLVING Tillaux-Chaput IN ADULTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 288-291. doi: 10.7507/1002-1892.20150062 Copy

1.	Court-Brown CM, Caesar B. Epidemiology of adult fractures:A review. Injury, 2006, 37(8):691-697.
2.	Rosenbaum AJ, DiPreta JA, Uhl RL. Review of distal tibial epiphyseal transitional fractures. Orthopedics, 2012, 35(12):1046-1049.
3.	Kim JR, Song KH, Song KJ, et al. Treatment outcomes of triplane and Tillaux fractures of the ankle in adolescence. Clin Orthop Surg, 2010, 2(1):34-38.
4.	Sharma B, Reddy IS, Meanock C. The adult Tillaux fracture:one not to miss. BMJ Case Reports, 2013, doi:10.1136/bcr-2013-200105.
5.	Cutler L, Molloy A, Dhukuram V, et al. Do CT scans aid assessment of distal tibial physeal fractures? J Bone Joint Surg (Br), 2004, 86(2):239-243.
6.	Brown SD, Kasser JR, Zurakowski D, et al. Analysis of 51 tibial triplane fractures using CT with multiplanar reconstruction. AJR Am J Roentgenol, 2004, 183(5):1489-1495.
7.	Goost H, Wimmer MD, Barg A, et al. Fractures of the ankle joint:investigation and treatment options. Deutsches Ärzteblatt International, 2014, 111(21):377-388.
8.	Gourineni P, Gupta A. Medial joint space widening of the ankle in displaced tillaux and triplane fractures in children. J Orthop Trauma, 2011, 25(10):608-611.
9.	Hamilton WC. Traumatic disorders of the ankle. New York:Springer, 1984:293.
10.	Ramsey P, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
11.	Thordarson DB, Motamed S, Hedman T, et al. The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg (Am), 1997, 79(12):1809-1815.
12.	Yang Y, Zhou J, Li B, et al. Operative exploration and reduction of syndesmosis in Weber type C ankle injury. Acta Ortop Bras, 2013, 21(2):103-108.
13.	Langenhuijsen JF, Heetveld MJ, Ultee JM, et al. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma, 2002, 53(1):55-60.
14.	Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures. Int Orthop, 2012, 36(9):1929-1936.
15.	Papachristou G, Efstathopoulos N, Levidiotis C, et al. Early weight bearing after posterior malleolar fractures:an experimental and prospective clinical study. J Foot Ankle Surg, 2003, 42(2):99-104.
16.	Hermans JJ, Beumer A, Hop WC, et al. Tibiofibular syndesmosis in acute ankle fractures:additional value of an oblique MR image plane. Skeletal Radiol, 2012, 41(2):193-202.
17.	Ogilvie-Harris DJ, Reed SC, Hedman TP. Disruption of the ankle syndesmosis:biomechanical study of the ligamentous restraints. Arthroscopy, 1994, 10(5):558-560.
18.	Candal-Couto JJ, Burrow D, Bromage S, et al. Instability of the tibio-fibular syndesmosis:have we been pulling in the wrong direction? Injury, 2004, 35(8):814-818.
19.	van den Bekerom MP, Raven EE. The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome:a current concepts review. Knee Surg Sports Traumatol Arthrosc, 2007, 15(4):465-471.
20.	Schlesinger I, Wedge JH. Percutaneous reduction and fixation of displaced juvenile Tillaux fractures:a new surgical technique. J Pediatr Orthop, 1993, 13(3):389-391.
21.	Duchesneau S, Fallat LM. The tillaux fracture. J Foot Ankle Surg, 1996, 35(2):127-133.
22.	Cooperman DR, Spiegel P, Laros G. Tibial fractures involving the ankle in children. The so-called triplane epiphyseal fracture. J Bone Joint Surg (Am), 1978, 60(8):1040-1046.
23.	Kumar N, Prasad M. Tillaux fracture of the ankle in an adult:a rare injury. J Foot Ankle Surg, 2014, 53(6):757-758.
24.	Oak NR, Sabb BJ, Kadakia AR, et al. Isolated adult tillaux fracture:a report of two cases. J Foot Ankle Surg, 2014, 53(4):489-492.
25.	Jennings MM, Lagaay P, Schuberth JM. Arthroscopic assisted fixation of juvenile intra-articular epiphyseal ankle fractures. J Foot Ankle Surg, 2007, 46(5):376-386.
26.	Ono A, Nishikawa S, Nagao A, et al. Arthroscopically assisted treatment of ankle fractures:arthroscopic findings and surgical outcomes. Arthroscopy, 2004, 20(6):627-631.

1. Court-Brown CM, Caesar B. Epidemiology of adult fractures:A review. Injury, 2006, 37(8):691-697.
2. Rosenbaum AJ, DiPreta JA, Uhl RL. Review of distal tibial epiphyseal transitional fractures. Orthopedics, 2012, 35(12):1046-1049.
3. Kim JR, Song KH, Song KJ, et al. Treatment outcomes of triplane and Tillaux fractures of the ankle in adolescence. Clin Orthop Surg, 2010, 2(1):34-38.
4. Sharma B, Reddy IS, Meanock C. The adult Tillaux fracture:one not to miss. BMJ Case Reports, 2013, doi:10.1136/bcr-2013-200105.
5. Cutler L, Molloy A, Dhukuram V, et al. Do CT scans aid assessment of distal tibial physeal fractures? J Bone Joint Surg (Br), 2004, 86(2):239-243.
6. Brown SD, Kasser JR, Zurakowski D, et al. Analysis of 51 tibial triplane fractures using CT with multiplanar reconstruction. AJR Am J Roentgenol, 2004, 183(5):1489-1495.
7. Goost H, Wimmer MD, Barg A, et al. Fractures of the ankle joint:investigation and treatment options. Deutsches Ärzteblatt International, 2014, 111(21):377-388.
8. Gourineni P, Gupta A. Medial joint space widening of the ankle in displaced tillaux and triplane fractures in children. J Orthop Trauma, 2011, 25(10):608-611.
9. Hamilton WC. Traumatic disorders of the ankle. New York:Springer, 1984:293.
10. Ramsey P, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg (Am), 1976, 58(3):356-357.
11. Thordarson DB, Motamed S, Hedman T, et al. The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg (Am), 1997, 79(12):1809-1815.
12. Yang Y, Zhou J, Li B, et al. Operative exploration and reduction of syndesmosis in Weber type C ankle injury. Acta Ortop Bras, 2013, 21(2):103-108.
13. Langenhuijsen JF, Heetveld MJ, Ultee JM, et al. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma, 2002, 53(1):55-60.
14. Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures. Int Orthop, 2012, 36(9):1929-1936.
15. Papachristou G, Efstathopoulos N, Levidiotis C, et al. Early weight bearing after posterior malleolar fractures:an experimental and prospective clinical study. J Foot Ankle Surg, 2003, 42(2):99-104.
16. Hermans JJ, Beumer A, Hop WC, et al. Tibiofibular syndesmosis in acute ankle fractures:additional value of an oblique MR image plane. Skeletal Radiol, 2012, 41(2):193-202.
17. Ogilvie-Harris DJ, Reed SC, Hedman TP. Disruption of the ankle syndesmosis:biomechanical study of the ligamentous restraints. Arthroscopy, 1994, 10(5):558-560.
18. Candal-Couto JJ, Burrow D, Bromage S, et al. Instability of the tibio-fibular syndesmosis:have we been pulling in the wrong direction? Injury, 2004, 35(8):814-818.
19. van den Bekerom MP, Raven EE. The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome:a current concepts review. Knee Surg Sports Traumatol Arthrosc, 2007, 15(4):465-471.
20. Schlesinger I, Wedge JH. Percutaneous reduction and fixation of displaced juvenile Tillaux fractures:a new surgical technique. J Pediatr Orthop, 1993, 13(3):389-391.
21. Duchesneau S, Fallat LM. The tillaux fracture. J Foot Ankle Surg, 1996, 35(2):127-133.
22. Cooperman DR, Spiegel P, Laros G. Tibial fractures involving the ankle in children. The so-called triplane epiphyseal fracture. J Bone Joint Surg (Am), 1978, 60(8):1040-1046.
23. Kumar N, Prasad M. Tillaux fracture of the ankle in an adult:a rare injury. J Foot Ankle Surg, 2014, 53(6):757-758.
24. Oak NR, Sabb BJ, Kadakia AR, et al. Isolated adult tillaux fracture:a report of two cases. J Foot Ankle Surg, 2014, 53(4):489-492.
25. Jennings MM, Lagaay P, Schuberth JM. Arthroscopic assisted fixation of juvenile intra-articular epiphyseal ankle fractures. J Foot Ankle Surg, 2007, 46(5):376-386.
26. Ono A, Nishikawa S, Nagao A, et al. Arthroscopically assisted treatment of ankle fractures:arthroscopic findings and surgical outcomes. Arthroscopy, 2004, 20(6):627-631.

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