Closed anatomic reduction of a juvenile Tillaux fracture by dorsiflexion of the ankle : a case report

The juvenile Tillaux fracture is a Salter-Harris Type III intraarticular fracture of the ankle in adolescent children whose distal tibial epiphyses are partially closed. Although there is general agreement that the major force of injury is one of external rotation, when closed reduction is attempted for displaced fractures by reversing the direction of this injuring force, i.e., by internal rotation of the foot on the leg as recommended, there is often failure to achieve satisfactory reduction. Consequently, the fracture is often treated by open reduction. Anatomic reduction was achieved and maintained by maximal dorsiflexion of the ankle. This method of treatment seems not to have been suggested before, and the pathway of reduction suggests that plantar flexion is the significant deforming force in this injury.