Children's Hospital of Soochow University, No. 92 Zhongnan street, Suzhou, Industrial Park, Jiangsu, China.
J Orthop Surg Res. 2020 Sep 17;15(1):423. doi: 10.1186/s13018-020-01961-7.
The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern.
The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores.
The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6-8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7.
Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.
青少年同侧的 Tillaux 骨折合并内踝骨折常因高能损伤而受累，治疗更为困难。本研究旨在探讨这种复杂骨折模式的损伤机制、诊断和治疗方法。
回顾了 6 例患者的病历和 X 线片。采用美国矫形足踝协会踝关节-后足评分评估功能。
手术时的平均年龄为 12.8 岁。从受伤到手术的平均间隔时间为 7.7 天。所有患者的 X 线正位片均显示 5 例 Tillaux 骨折和所有内踝骨折。轴向 CT 证实 1 例 Tillaux 骨折和 2 例后外胫骨撕脱。3 例有外侧距骨半脱位伴内侧间隙增宽，1 例有下胫腓联合分离。5 例患者合并同侧腓骨远端骨折。除 2 例内踝骨折和 1 例 Tillaux 骨折不愈合外，所有骨折均在 6-8 周内愈合。有 1 例出现踝关节骨关节炎。AOFAS 平均评分为 88.7。
CT 有助于识别骨折类型。建议解剖复位和内固定 Tillaux 骨折和内踝骨折，以恢复关节面的一致性和踝关节的稳定性。
