Mechanism of injury of transitional ankle fractures

Czech version

Authors: Tomáš Pešl; Petr Havránek
Authors‘ workplace: Klinika dětské chirurgie a traumatologie 3. LF Univerzity Karlovy v Praze Fakultní Thomayerova nemocnice v Praze, Krči Dept. of Pediatric and Trauma Surgery ; rd Faculty of Medicine Charles University Thomayer Teaching Hospital, Prague, Czech Republic ³
Published in: Úraz chir. 18., 2010, č.2

Tématika předkládané práce je podporována grantem IGA MZ ČR reg. č. NS10428-3/2009. Etická komise vyslovila s projektem souhlas.

Overview

Aim of the study:
Juvenile Tillaux and triplane fractures are believed to be caused by avulsion of the lateral portion of the tibial epiphysis by the anterior tibiofibular ligament. On the other hand, Ogden presumed that as the foot is externally rotated, the talus develops a compressiontorque stress creating a crack through the articular surface up to the growth plate, which then shears. However, there is no evidence of these theories in scientific literature and that is why we made an attempt to verify these two theories.

Material and methods:
All patients with juvenile Tillaux (JTF) or triplane fractures (TF) treated in our department during the period 1990–2009 (20 yrs) were reviewed. Beside this, we have reviewed also osteochondral fractures of the talar dome in patients treated for ankle injury during the same period.

Results:
One hundred and fiftynine patients were diagnosed with JTF or TF. Fifty children had JTF and one hundred and nine had TF (ni-nety nine lateral and ten medial TF). Osteochondral fracture of the talar dome was identified in twenty five adolescent patients with cessation of distal tibial growth (seventeen on the lateral trochlear edge and eight on the medial trochlear edge). In our cohort of transitional fractures, there were four patients with intraepiphyseal fractures of the tibial mortise located out of the ligamental insertion.

Conclusion:
Osteochondral fractures of the lateral edge of the talar dome and intraepiphyseal fractures of the tibial mortise (located out of the insertion of the anterior tibiofibular ligament) indicate, that the Ogden’s pathomechanical „shearing“ theory of transitional ankle fractures is much more probable than the „avulsion“ theory.

Key words:
tibia, talus, osteochondral fracture, physis, fracture, child.

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Surgery Traumatology Trauma surgery

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Article was published in

Trauma Surgery

2010 Issue 2