The Tillaux fracture is a transitional fracture of the anterolateral distal tibial epiphysis. This typically occurs in older children. The amount of remaining growth is therefore negligible, and crossing the physis with screws is permitted.
Displaced articular fractures require an open approach, with anatomical reduction to restore the articular surface and align the physis.
A CT scan is recommended for diagnosis and preoperative planning.
Screws can either be placed within the epiphysis …
… or crossing the physis into the metaphysis.
If the fragment is sufficiently large, two screws can be used.
Anatomical restoration of these fractures reduces the risks of malunion and subsequent osteoarthritis.
2. Instruments and implants
Appropriately sized cannulated or noncannulated lag screws (2.7, 3.5, or 4.0 mm) can be used.