- Email: [email protected]
Arthroscopically assisted reduction and fixation of an adult tillaux fracture of the ankle
Case Report
Arthroscopically Assisted Reduction and Fixation of an Adult Tillaux Fracture of the Ankle Mark D. Miller, M.D.
Summary: We describe the first report of arthroscopically-assisted reduction and fixation of an adult Tillanx fracture. Anatomic reduction of the fracture was possible with arthroscopic visualization. Adjunctive use of the arthroscope for accurate reduction of intraarticular fractures, which has been successful in the management of distal radius and tibial plateau fractures, can also be used for adult Tillaux fractures of the ankle. Key Words: Tillaux fracture--Ankle arthroscopy--Ankle fracture.
vulsion fractures of the anterior lateral margin of the tibia by the anterior tibiofibular ligament, named after Tillaux, occur at a similar location in adults as the juvenile variety, which is actually a SalterHarris III fracture. 1 These injuries are, by definition, intraarticular, and principles of anatomic reduction and fixation apply. Although arthroscopy has been successfully used to assist in anatomic reduction of other intraarticular fractures such as the tibial plateau 2'3 and distal radius, 4'5 we are unaware of any reported application of this technique for intraarticular ankle fractures. We report the first arthroscopically-assisted reduction and fixation of an adult Tillaux fracture of the ankle.
A
CASE REPORT A 58-year-old woman tripped and fell on the steps of her motor home, injuring her left ankle. Although the exact mechanism of injury is unclear, she apparently sustained a supination/external rotation force. Plain radiographs (Fig 1) suggested that there was in-
From the Uniformed Services University, Associate Team Physician, United States Air Force Academy, Colorado, U.S.A. Address correspondence and reprint requests to Mark D. Miller, M.D., IO MDG/SGOSO, 4102 Pinion Dr, Suite 100, USAF Academy, CO 80840, U.S.A. © 1997 by the Arthroscopy Association of North America 0749-8063/97/1301-156853.00/0
congruity of the distal articular surface of the tibia, and computed axial tomography (CT scan) was obtained, clearly demonstrating an adult Tillaux fracture of the distal tibia (Fig 2). After discussion with the patient, operative treatment was decided upon. Arthroscopy was carried out through the standard anterior portals. The fracture was easily visualized, and the articular incongruity confirmed (Fig 3). The anterolateral portal was extended and the extraarticular margins of the fracture were identified and debrided. The fracture was reduced, provisionally fixed, and both fluoroscopy and arthroscopy (Fig 4) were used to confirm the adequacy of the reduction. Two 3.5 m m cortical interfragmentary screws were used to fix the fracture (Fig 5). Postoperatively, the patient was placed in a splint for 1 week, and then early motion was encouraged. She went on to a successful union, and has had no problems with her ankle.
DISCUSSION Arthroscopy is a useful adjunct in the management of intraarticular fractures. It has been successfully used for fractures of the tibial plateau and the distal radius. Application of these techniques for other joints is simply a matter of understanding the local arthroscopic anatomy.
Arthroscopy." The Journal of Arthroscopic and Related Surgery, Vol 13, No 1 (February), 1997: pp 117-119
117
118
M. D. MILLER
FIG 3. Arthoscopic view (Anterolateral portal) of the displaced fracture fragment.
A n a t o m i c reduction of intraarticular fractures, which was accomplished with the use of arthroscopy in this case, is a goal in the treatment of all fractures. 6 Arthroscopy provides an excellent view of the articular surface of the distal tibia with m i n i m a l soft tissue disruption. Arthroscopy is a valuable adjunct in the treatment of intraarticular adult Tillaux fractures.
FIG 1. Anteroposterior radiograph of left ankle demonstrating an intraarticularfracture of the lateral margin of the distal tibia (arrow).
FIG 2. CoronalHelical Computed Axial Tomographyreconstruction of left ankle Tillaux fracture (General Electric High-Speed Helical scanner). (Image courtesy of John R. Osborne, M.D.).
FIG 4. Arthroscopic view (Anteromedialportal) following reduction.
A R T H R O S C O P I C A L L Y A S S I S T E D T I L L A U X ORIF
119
FIG 5. Anteroposterior radiograph of left ankle following anatomic reduction and percutaneous fixation of adult Tillaux fracture.
REFERENCES 1. Sartoris DJ. Eponymic fractures of the ankle. J Foot Ankle Surg 1993;32:239-241. 2. Caspari R, Hutton P, Whipple T, and Meyers J. The role of arthroscopy in the management of tibial plateau fractures. Arthroscopy 1984; 1:76-82. 3. Jennings J. Arthroscopic management of tibial plateau fractures. Arthroscopy 1985; 1:160-168. 4. Cooney WP, Berger RA. Treatment of complex fractures of the distal, radius. Combined use of internal and external fixation and arthroscopic reduction. Hand Clin 1993;9:603-612. 5. Geissler WB, Freeland AE. Arthroscopically assisted reduction of intraarticular distal radial fractures. Clin Orthop 1996;327: 125-134. 6. Browner BD, Mast J, Mendes M. Principles of internal fixation. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. Philadelphia: W.B. Saunders, 1992;243-268.
Arthroscopically Assisted Reduction and Fixation of an Adult Tillaux Fracture of the Ankle Mark D. Miller, M.D.
Summary: We describe the first report of arthroscopically-assisted reduction and fixation of an adult Tillanx fracture. Anatomic reduction of the fracture was possible with arthroscopic visualization. Adjunctive use of the arthroscope for accurate reduction of intraarticular fractures, which has been successful in the management of distal radius and tibial plateau fractures, can also be used for adult Tillaux fractures of the ankle. Key Words: Tillaux fracture--Ankle arthroscopy--Ankle fracture.
vulsion fractures of the anterior lateral margin of the tibia by the anterior tibiofibular ligament, named after Tillaux, occur at a similar location in adults as the juvenile variety, which is actually a SalterHarris III fracture. 1 These injuries are, by definition, intraarticular, and principles of anatomic reduction and fixation apply. Although arthroscopy has been successfully used to assist in anatomic reduction of other intraarticular fractures such as the tibial plateau 2'3 and distal radius, 4'5 we are unaware of any reported application of this technique for intraarticular ankle fractures. We report the first arthroscopically-assisted reduction and fixation of an adult Tillaux fracture of the ankle.
A
CASE REPORT A 58-year-old woman tripped and fell on the steps of her motor home, injuring her left ankle. Although the exact mechanism of injury is unclear, she apparently sustained a supination/external rotation force. Plain radiographs (Fig 1) suggested that there was in-
From the Uniformed Services University, Associate Team Physician, United States Air Force Academy, Colorado, U.S.A. Address correspondence and reprint requests to Mark D. Miller, M.D., IO MDG/SGOSO, 4102 Pinion Dr, Suite 100, USAF Academy, CO 80840, U.S.A. © 1997 by the Arthroscopy Association of North America 0749-8063/97/1301-156853.00/0
congruity of the distal articular surface of the tibia, and computed axial tomography (CT scan) was obtained, clearly demonstrating an adult Tillaux fracture of the distal tibia (Fig 2). After discussion with the patient, operative treatment was decided upon. Arthroscopy was carried out through the standard anterior portals. The fracture was easily visualized, and the articular incongruity confirmed (Fig 3). The anterolateral portal was extended and the extraarticular margins of the fracture were identified and debrided. The fracture was reduced, provisionally fixed, and both fluoroscopy and arthroscopy (Fig 4) were used to confirm the adequacy of the reduction. Two 3.5 m m cortical interfragmentary screws were used to fix the fracture (Fig 5). Postoperatively, the patient was placed in a splint for 1 week, and then early motion was encouraged. She went on to a successful union, and has had no problems with her ankle.
DISCUSSION Arthroscopy is a useful adjunct in the management of intraarticular fractures. It has been successfully used for fractures of the tibial plateau and the distal radius. Application of these techniques for other joints is simply a matter of understanding the local arthroscopic anatomy.
Arthroscopy." The Journal of Arthroscopic and Related Surgery, Vol 13, No 1 (February), 1997: pp 117-119
117
118
M. D. MILLER
FIG 3. Arthoscopic view (Anterolateral portal) of the displaced fracture fragment.
A n a t o m i c reduction of intraarticular fractures, which was accomplished with the use of arthroscopy in this case, is a goal in the treatment of all fractures. 6 Arthroscopy provides an excellent view of the articular surface of the distal tibia with m i n i m a l soft tissue disruption. Arthroscopy is a valuable adjunct in the treatment of intraarticular adult Tillaux fractures.
FIG 1. Anteroposterior radiograph of left ankle demonstrating an intraarticularfracture of the lateral margin of the distal tibia (arrow).
FIG 2. CoronalHelical Computed Axial Tomographyreconstruction of left ankle Tillaux fracture (General Electric High-Speed Helical scanner). (Image courtesy of John R. Osborne, M.D.).
FIG 4. Arthroscopic view (Anteromedialportal) following reduction.
A R T H R O S C O P I C A L L Y A S S I S T E D T I L L A U X ORIF
119
FIG 5. Anteroposterior radiograph of left ankle following anatomic reduction and percutaneous fixation of adult Tillaux fracture.
REFERENCES 1. Sartoris DJ. Eponymic fractures of the ankle. J Foot Ankle Surg 1993;32:239-241. 2. Caspari R, Hutton P, Whipple T, and Meyers J. The role of arthroscopy in the management of tibial plateau fractures. Arthroscopy 1984; 1:76-82. 3. Jennings J. Arthroscopic management of tibial plateau fractures. Arthroscopy 1985; 1:160-168. 4. Cooney WP, Berger RA. Treatment of complex fractures of the distal, radius. Combined use of internal and external fixation and arthroscopic reduction. Hand Clin 1993;9:603-612. 5. Geissler WB, Freeland AE. Arthroscopically assisted reduction of intraarticular distal radial fractures. Clin Orthop 1996;327: 125-134. 6. Browner BD, Mast J, Mendes M. Principles of internal fixation. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. Philadelphia: W.B. Saunders, 1992;243-268.