Juvenile Tillaux Ankle Fracture S82.899A 824.8

synonyms:

Juvenile Tillaux Fx ICD-10

• S82.891A - Other fracture of right lower leg, initial encounter for closed fracture
• S82.892A - Other fracture of left lower leg, initial encounter for closed fracture
• S82.899A - Other fracture of unspecified lower leg, initial encounter for closed fracture

A- initial encounter for closed fracture

B- initial encounter for open fracture type I or II

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for closed fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for closed fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for closed fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for closed fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

Juvenile Tillaux Fx ICD-9

• 824.8 Fracture of ankle; unspecified, closed
• 824.9 Fracture of ankle; unspecified, open

Juvenile Tillaux Fx Etiology / Epidemiology / Natural History

• A Salter-Harris type II distal tibial fracture involving the anterolateral distal tibia.
• A form of transitional ankle fracture related to the asymmetric pattern of distal tibial physeal closure.
• Occur in early adolescence
• Thought to be caused by external rotation forces.

Juvenile Tillaux Fx Anatomy

• Fracture results from avulsion by the anterior tibiofibular ligament.
• Distal tibial growth plate closure starts anteromedially, progresses posteriorly and laterally and finishes anterolaterally.

Juvenile Tillaux Fx Clinical Evaluation

• Pain and deformity in the ankle, degree dependent on fracture severity.
• Evaluate skin integrity, swelling, and neurovascular status of the leg/foot.

Juvenile Tillaux Fx Xray / Diagnositc Tests

• A/P, lateral and mortise views of the ankle. Appears like a Tillaux fracture on A/P and mortise views.
• CT generally indicated. Demonstrates that fracture line does not extend through the anterior cortex. (Horn BD, JPO 2001;21:162)(link is external).
• MRI generally not indicated although can provide information on ligamentous and physeal injury. (Lohman M, Skeletal Tadiol 2001;30:504)(link is external).

Juvenile Tillaux Fx Classification / Treatment

• Nondisplaced: immobilization
• Displaced (>2mm): open or closed reduction and fixation with cannulated screws

Juvenile Tillaux Fx Associated Injuries / Differential Diagnosis

• Pediatric Distal Tibial Fracture
• Triplane Ankle Fracture
• Adolescent Pilon Fracture
• Incisural Ankle Fracture

Juvenile Tillaux Fx Complications

• Delayed union, nonunion
• Malunion
• Growth arrest (uncommon)
• Arthritis
• Osteonecrosis of the distal tibial epiphysis
• Compartment syndrome

Juvenile Tillaux Fx Follow-up Care

Juvenile Tillaux Fx Review References

• Lovell and Winter's Pediatric Orthopaedics 2012(link is external)
• Rockwood and Wilkin's Fractures in Children 6th ed, 2006(link is external)
• °