Spiral tibiofibular fractures complicated by ipsilateral Tillaux and posterior malleolus fractures in adults—A rare injury patterns: case report

Abstract

Abstract BackgroundAn avulsion fracture of the distal tibia caused by severe traction of the anterior-inferior tibiofibular ligament (AITFL) is called a Tillaux fracture. This injury is rare in adults because the AITFL is usually broken before a Tillaux fracture. This case report describes, for the first time, an adult spiral tibiofibular fracture combined with ipsilateral Tillaux and posterior malleolus fractures and discusses the injury mechanism, diagnosis, and treatment. Case A 45-year-old female experienced a slip and fall while walking. She experienced pain and swelling of the right calf, external rotation deformity of the right foot, and limited mobility. The X-ray imaging showed a tibiofibular spiral fracture, followed by a computed tomography (CT) scan that identified an associated ankle and Tillaux fractures. After the diagnosis was confirmed, AITFL tension was restored by open reduction and lag nail fixation of the Tillaux fracture. Subsequently, the posterior malleolus was stabilized using a cannulated nail to restore the alignment and stability of the tibiotalar joint. Finally, the spiral fracture of the tibia was fixed with an intramedullary nail, successfully restoring the normal anatomical structure of the patient. Conclusions Adult Tillaux fractures combined with other fractures are rare and can be easily misdiagnosed. CT examination should be performed to confirm the diagnosis. Reduction and fixation can achieve satisfactory results in patients with a Tillaux fracture fragment displacement > 2 mm.