Oblique Compression Screw Fixation across the Physis for Tillaux Fractures in Adolescent

Author(s): Nicholas I Pilla, Mikayla Borusiewicz, Emily Smith, William L Hennrikus

Objective: Tillaux fractures are uncommon physeal injuries sustained by adolescents. Two different fixation techniques are described; the first involves placement of a screw obliquely into the tibial metaphysis, while the second involves placement of a screw parallel through the epiphysis without violating the physis. The purpose of this study was to report the outcomes, complications, and advantages of oblique screw fixation.

 Methods: This study was approved by the College of Medicine institutional review board. Ten patients with displaced Tillaux fractures were reviewed. All patients underwent attempted closed reduction first. Open reduction and internal fixation was performed using a 4 mm solid partially threaded screw that crossed the physis. A short-leg non-weight bearing cast was placed for 3 weeks followed by a CAM boot.

 Results: Outcomes measured included subjective pain and range of motion. No patient had pain, arthritis, stiffness, or limitations at final follow up. All returned to pre-injury sports as tolerated. Six patients had hardware removed. All patients had equal range of motion and no pain following oblique screw fixation.

 Conclusion: Tillaux fractures are uncommon ankle injuries occurring in adolescents. Open reduction is recommended if there is more than 2 mm of fracture displacement. All patients in the current study reported equal outcomes of pain and range of motion. Use of an oblique screw resulted in excellent outcomes with no complications of growth arrest, arthritis, stiffness, or infection. This study demonstrates the advantages of the oblique screw placement including a technically simple, fast, and safe procedure.

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