Giacobazzi Mario, Gologram Makayla, Mitchell Robert, Kasik Connor, Gonzalez Noah M
Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Erie, USA.
Orthopedic Surgery, Illinois Valley Orthopedics, St. Margaret's Health, Peru, USA.
Cureus. 2023 May 29;15(5):e39651. doi: 10.7759/cureus.39651. eCollection 2023 May.
The Salter-Harris classification system categorizes pediatric fractures in relation to the physis. A Salter-Harris type III fracture occurs from the physis extending to the epiphysis. Tillaux fractures are a type of Salter-Harris type III fracture that occurs due to incomplete fusion of the growth plate and includes the anterolateral tibial epiphysis. This specific fracture is unique to adolescents due to the anterior tibiofibular ligament's strength in relation to the growth plate, causing avulsion of the tibial fragment. The settings for a Tillaux fracture and a Salter-Harris type III fracture are uncommon due to the mechanism of injury, and it is incredibly rare to have two separate fractures of these classifications in the same ankle. In this case study, a 16-year-old male presented to the emergency department after sustaining trauma to the right ankle via a skateboarding accident. Initial radiographs showed no evidence of acute fracture, and CT imaging was performed. CT scan of the right lower leg found a Tillaux fracture of the distal right tibia with a 2 mm displacement and a nondisplaced Salter-Harris type III distal fibula fracture. Closed reduction and percutaneous screw fixation of the distal tibia fracture were performed. The repair of this fracture was complicated due to the presence of two distinct fractures. This case study aims to provide a viable option to successfully repair this complex presentation as well as explain imaging findings that differentiate this fracture from other pathologies that are not managed operatively.
Salter-Harris分类系统根据骨骺对儿童骨折进行分类。Salter-Harris III型骨折是指从骨骺延伸至干骺端的骨折。Tillaux骨折是Salter-Harris III型骨折的一种，由于生长板未完全融合所致，包括胫骨前外侧骨骺。由于胫腓前韧带相对于生长板的强度，导致胫骨骨折块撕脱，这种特殊骨折在青少年中较为独特。由于损伤机制，Tillaux骨折和Salter-Harris III型骨折的发生情况并不常见，在同一踝关节出现两种不同类型的此类骨折极为罕见。在本病例研究中，一名16岁男性在滑板事故中右踝受伤后被送往急诊科。最初的X线片未显示急性骨折迹象，遂进行了CT成像检查。右下肢CT扫描发现右胫骨远端Tillaux骨折，移位2mm，同时伴有无移位的Salter-Harris III型腓骨远端骨折。对胫骨远端骨折进行了闭合复位和经皮螺钉固定。由于存在两种不同的骨折，该骨折的修复过程较为复杂。本病例研究旨在提供一种可行的方法来成功修复这种复杂的骨折情况，并解释影像学表现，以将这种骨折与其他非手术治疗的病变区分开来。
