Painful Nonunion after Missed Juvenile Tillaux Fracture in an Athlete - Case Report and Description of a New Fixation Technique

INTRODUCTION: The Tillaux fracture is a rare subtype of tibial physeal fracture that usually occurs in adolescents. There are only a few case series or reports published in the literature and, to our knowledge, this is the first time, a painful nonunion is reported after this type of fracture. CASE REPORT: A 13-year-old athlete presented to our orthopedic department because of persistent pain after an acute ankle injury 2months before. She was diagnosed with a Tillaux fracture that eventually progressed to nonunion after conservative treatment. Surgery was performed to treat the nonunion, and the fracture fragment was fixed using a soft suture anchor. CONCLUSION: The Tillaux fracture pattern requires a high level of clinical suspicion and careful evaluation since it can be misdiagnosed as a simple ankle sprain in adolescents and progress to persistent ankle pain without appropriate treatment. Our surgical technique of suture anchor fixation avoids the risk of fragmentation of the fracture fragment and was able to provide an excellent clinical result.