Korean J Sports Med.  2022 Sep;40(3):204-208. 10.5763/kjsm.2022.40.3.204.

Adult Tillaux-Chaput Tubercle Fracture with Volkmann Fracture during Tennis: A Case Report

Affiliations
  • 1Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea

Abstract

An avulsion fracture of the anterolateral tibial epiphysis or Tillaux fracture is commonly seen in adolescents, reported first by Paul Jules Tillaux in 1892. Adolescent Tillaux fracture occurs during the period when the lateral physis is still open and the anterior-inferior tibiofibular ligament is stronger than the physis, so rarely occurs in adults. An avulsion fracture of the posterior inferior tibiofibular ligament, Volkmann fracture, occurs counterpart of Tillaux fracture. In this study, a tennis player injured during sliding and diagnosed as the rare simultaneous Tillaux-Chaput fracture and Volkmann fracture, is reported with the mechanism of injury, clinical importance of syndesmosis, sprain, and fracture of the ankle joint.

Keyword

Tillaux fracture; Tillaux-Chaput fracture; Volkmann fracture; Ankle sprain; Syndesmotic injury; Tennis injury

Figure

  • Fig. 1 An axial (A) and coronal (B) computed tomography images of the injured ankle. A nondisplaced fracture was found as anterolateral Tillaux-Chaput fracture. No definitive other fracture was seen on these images.

  • Fig. 2 Magnetic resonance imaging scans showed partial anterior-inferior tibiofibular ligament rupture and extra-articular Volk-mann fracture on axial (A) and sagittal (B) images. On coronal views (C), deltoid ligaments and medial malleolus was relatively intact, but the ankle was swollen.

  • Fig. 3 Illustration of the sliding moment during tennis. During sliding right after dash to the tennis ball, the contralateral ankle is dragged with pronated position (arrow).

  • Fig. 4 Modified Wagstaffe classification of anterior inferior tibiofibular ligament (AITFL) avulsion fractures. Type 1: isolated AITFL avulsion fracture of the fibula without lateral malleolar fracture. Type II: AITFL avulsion fracture of the fibula with lateral malleolar fracture. Type III: AITFL avulsion fracture of the tibia with lateral malleolar fracture. Type IV: AITFL avulsion fracture of both the tibia and fibula with lateral malleolar fracture.

  • Fig. 5 Cross-sectional illustration of distal tibiofibular syndesmosis and ligaments. (A) Anterior-inferior tibiofibular ligament (AITFL), posterior-inferior tibiofibular ligament (PITFL), and the interosseous ligament (IOL). The ankle joint is stabilized mostly with these ligaments. (B) The unstable ankle joint by syndesmosis instability followed by avulsion fractures by AITFL and PITFL (Tillaux-Chaput fracture with Volkmann fracture).


Reference

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