Question
A 13 year old girl twists her ankle playing netball and has anterolateral ankle pain.
- What is the injury and why does it occur at this age?
- How is it investigated?
- How is it managed?
Answer
Diagnosis
- Juvenile Tillaux fracture, a Salter-Harris III fracture of the anterolateral distal tibial epiphysis
- Avulsed by the anterior inferior tibiofibular ligament in external rotation
- The distal tibial physis closes centrally, then medially, then laterally over about 18 months, leaving the lateral part open
Investigation
- CT to measure displacement
- A coronal metaphyseal fracture line indicates a triplane fracture instead
- Mortise view shows the fragment best on radiographs
Management
- Displacement under 2 mm, cast immobilisation
- Displacement over 2 mm, closed reduction by internal rotation and a percutaneous screw parallel to the physis, or open reduction
- Growth disturbance is uncommon as growth is nearly complete
- Outcome depends on articular congruity
- Non weight bearing for about 6 weeks
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.