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Of the six published case reports in patients over 18 years old, only one had Tillaux fracture associated with Volkmann fracture, and none of them had association with Maisonneuve fracture.In the present report, we describe the case of a Tillaux fracture in an adult, associates with a Volkmann and a Maisonneuve fractures. Tillaux fractures have rarely been reported in adults. Maisonneuve fracture is an injury caused by a pronation-external rotation force at the ankle that results in rupture along the syndesmosis with its diastasis, lateral talar shift and spiral fracture of the proximal half of the fibula. External rotation forces make the talus rotate further laterally and the posteroinferior tibiofibular ligament (PITFL) stretch, thus either the PITFL will rupture or an avulsion fracture from the posterolateral tibia occur. Volkmann fracture generally occurs in ankle fracture due to either mechanism of pronation or supination with external rotation. Adolescent Tillaux fracture occurs during transition period when the medial and central physis has finished closure, but the lateral physis still open. The interval (∼18 months) during which the distal tibial physis completes its closure and gains maturity is referred to as “transition period”. The medial closure occurs at approximately 13 to 14 years of age, with lateral closure beginning at 14.5 to 16 years of age.

Finally, the lateral aspect of distal tibial fusion occurs. Physeal closure starts from the center and then progresses toward the medial side. 5 In children, the size of the fracture depends on the extent of the fusion medially, because distal tibial epiphyseal closure has an asymmetric pattern. 1–4 The mechanism of this fracture is typically supination with external rotation. In adults, differ from children, the ligament generally gives away before avulsion of its attachment to the anterolateral tibial plafond occurs, leading to relative rarity of this avulsion pattern. Tillaux fracture is an avulsion fracture of the anterolateral aspect of the tibial plafond owing to the pull of a taut anteroinferior tibiofibular ligament (AITL).