A 13-year-old male presented with ankle pain after twisting his foot while hiking. On examination, he had limited range of motion in his right ankle with marked swelling and tenderness. Radiographs revealed a Salter Harris III fracture involving avulsion of the anterolateral tibial epiphysis. He was treated with pain control, orthopedic consultation for possible open reduction and internal fixation, and stabilization in a long leg cast or splint with orthopedic follow-up.

2.  13YOM presents with the
complaint of ankle pain.
The patient was hiking
with friends and family
when his foot got caught
and he “twisted” his ankle.
He has been unable to bear
weight and is complaining
of marked swelling.
 T 98.7 P 98 BP 126/84 O2




99%
Gen: WDWN, obvious pain
CV: RRR, no m/r/g
Pulm: Lungs CTA bilat
Musc: Limited active and
passive ROM R ankle;
marked swelling and TTP
of anterior R ankle; no TTP
over medial and lateral
malleolus

4.  Red arrow: Salter Harris III fracture involving
avulsion of anterolateral tibial epiphysis

5.  Pain control
 Orthopedic Consultation for possible ORIF
 Displacement of >2mm requires ORIF
 Stabilization/Closed Reduction
 Internal rotation of ankle and supination of the foot
with pressure on fracture fragment
 Stabilization in long leg cast or stirrup splint with
posterior slab
 Prompt orthopedic follow-up

6.  Fracture occurs in adolescents w/ relatively mature
growth plates; therefore, there is minimal potential for
deformity due to growth plate injury
 Needs to be differentiated from a triplane fracture,
which is a salter harris IV fracture that extends
through the epiphysis, physis, and metaphysis

8.  http://www.radpod.org/2007/07/20/tillaux-fracture/
 http://radiologyschools.com/Radiology-
Courses/ext/8ankle/33.html
 http://www.wheelessonline.com/ortho/tillaux_fractur
e
 http://www.joint-pain-expert.net/tillaux-fracture.html
 Pediatric Emergency Medicine. Chapter 38 Injuries of
the Pelvis and Lower Extremities