231 Tillaux Fracture in a 40-Year-Old Man: A Rare Case Report

Abstract Tillaux fracture is an intra-articular Salter-Harris III fracture affecting the anterolateral aspect of the distal tibia. It is commonly seen in children and adolescents but rare for adults. As Tillaux fracture can be unstable, misdiagnosis may result in delayed surgical treatment and development of complications such as post-traumatic arthritis and persistent syndesmotic instability. A case of adult Tillaux fracture is reported, involving a 40-year-old gentleman who sustained a low energy injury. He presented to local hospital after being assaulted by a stranger. He tripped over a low fence and sprained his left ankle in external rotation. On examination, he was not able to weight bear. There were swelling and focal tenderness at the triangular concavity of distal fibula. Ankle X-Ray was reported as normal. It required CT scan for diagnosis after reviewed by orthopaedics team at fracture clinic. The patient was subsequently treated with lag screw fixation and recovered after 6 weeks post-operatively. This case highlights the importance of a systematic method to interpret ankle X-Ray. It is essential to observe the tibio-fibular overlap and any change in the outline of bony cortex of the fibular notch. CT scan has a high sensitivity in delineating fracture pattern hence it should be performed when there is difficulty to confirm the diagnosis solely based on X-Ray. In conclusion, Tillaux fracture should be suspected when patients present with external rotation injury. There should be low threshold to perform CT scan when there is any uncertainty with the ankle X-Ray interpretation.