Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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The juvenile Tillaux fracture is an avulsion fracture (Salter-Harris type-3) of the anterolateral comer of the distal tibial epiphysis. We present a case in which the severely displaced Tillaux fragment became incarcerated between the distal tibia and fibula, simulating a syndesmotic separation radiographically. To our knowledge, such a fracture pattern as not been previously described. Preoperative computerized tomography provided accurate imaging of the unusual fracture pattern. Open extrication of the fracture fragment was followed by spontaneous reduction of the syndesmosis. The Tillaux fracture healed following open reduction with pin fixation, and the patient had an excellent functional and radiographic result at 2-year follow-up.