Title: Open Reduction and Internal Fixation in Displaced Juvenile Tillaux Fractures
Authors: Ahmet Kaya, Taskin Altay, Hasan Ozturk, and Levent Karapinar
Source: Injury, International Journal of the Care of the Injured. 2007; 38: 201-205.
PODIATRIC RELEVANCE:
Juvenile tillaux fractures are a relatively uncommon injury. A review of the literature shows no exact established protocol or consensus on the treatment of such fractures. These fractures are sometimes treated with closed reduction first and if this fails, open reduction is recommended. The question arises as to how much displacement is significant to define a failure at closed reduction or to warrant open reduction. The focus of this study states that any juvenile tillaux fracture with more than 2 mm of displacement should be treated with open reduction. The objective of this study was to show the results of open reduction internal fixation of juvenile tillaux fractures with more than 2 mm of displacement without any attempt at closed reduction.
METHODS:
In this article, the study consisted of six girls and fours boys with a mean age of 13.1 years. The amount of displacement of the juvenile tillaux fracture was 2-4 mm for all patients. All patients included in the study underwent the following protocol. All patients were operated on the day of admission. Closed reduction was not attempted on any patient prior to surgery. The fractures were all approached from an anterolateral incision. After reduction of the fracture fragment under direct visualization, the fracture was fixated with a 3.5 mm malleolar screw directed horizontally into the epiphysis. Extreme care was taken not to cross the physis. A short leg cast was then applied with the ankle in neutral position. This cast was left on for 6 weeks. Active ankle motion and full weight bearing was initiated at 12 weeks. In 4 of 10 cases, the screws were removed with a second operation. All patients in the study were evaluated with the ankle score of the American Orthopaedic Foot and Ankle Society (AOFAS).
RESULTS:
All patients were followed for a mean of 54 months. The mean AOFAS scores were 99.3 at the latest follow-up visit. This indicated that all patients except one had little to no pain, full range of motion, and no limitation of activities. One patient had limitations in recreational activities. Two patients had limited range of motion (10 degrees loss of plantar flexion). All fractures in all patients were found to be healed in anatomic position at final follow-up.
COMMENTS:
This study discusses whether juvenile tillaux fractures should be treated by closed reduction first or with open reduction internal fixation. They state that it is generally accepted that closed reduction is attempted first, and if this fails then internal fixation is recommended. The critical point it to achieve a reduction with no more than 2 mm of displacement. They recommend that if less than 2 mm of displacement is observed on plain radiographs, a CT scan should be ordered to accurately visualize the amount of displacement. The authors in this study prefer open reduction internal fixation in all tillaux fractures that have 2 mm or more of displacement. This study demonstrated that all patients with more than 2 mm of displacement treated with open reduction internal fixation achieved excellent results. The results support the use of internal fixation for juvenile tillaux fractures with more than 2 mm of displacement without any attempt at closed reduction. Additional studies are needed on this topic with larger series, control groups, and longer follow-up periods.
________________________________________________________________________________________
Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.