AIPGMEE 2016 MCQ orthopedics

In relation to Tillaux fractures, in which order does the distal tibial physis close?

a. Central – medial – lateral; anterior – posterior.
b. Central – lateral – medial; anterior – posterior.
c. Central – medial – lateral; posterior – anterior.
d. Central – lateral – medial; posterior – anterior.
e. Medial – central – lateral; posterior – anterior.

Ans- c. Central – medial – lateral; posterior – anterior.

A Tillaux fracture is a Salter–Harris III avulsion injury of the anterolateral distal tibial
physis by the anterior tibiofibular ligament (ATFL). It occurs following a low energy
external rotation injury mechanism between the ages of 11 and 15 more commonly in girls
and during sporting activities. It is the sequence of physeal closure at the distal tibia
which accounts for this pattern of injury. Physeal closure begins with the central third,
followed by the medial third and lastly the lateral third. Closure also occurs in a posterior to
anterior direction and therefore, with injury, the strong ATFL avulses the relatively weak
anterolateral portion of the epiphysis. The fragment is usually displaced anterolaterally and
there may be associated diastasis. The Tillaux fragment should be fixed if displacement
is >2 mm.