Adolescents are susceptible to relatively uncommon Salter Harris III fractures of the distal tibia, known as Tillaux fractures. This is due to the fact that the closure of the distal tibia physis occurs over an 18-month period between the ages of 12 and 15 years. Thus, in the setting of an external rotation force to the distal tibia during this specific period of time, a Tillaux fracture can occur. Following closed reduction in a long leg cast, computed tomography (CT) scans are needed to adequately assess joint congruity. This is critical, as a gap of 2 mm or more can lead to residual deformity of the articular surface resulting in premature degenerative arthritis of the ankle joint. Therefore, in order to ensure accuracy of fixation, these periarticular fractures are usually treated with cannulated screws. Regardless of the treatment modality, anatomic reduction of the articular surface is the goal of care.
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References and Suggested Reading
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