Tillaux Fracture Associated with Adult Ankle Fracture Injury.

Tillaux fractures in adults are rare and, if unrecognized, can lead to ankle fracture healing complications, early progression of arthritis, and limited ankle movement caused by pain and degenerative changes. The Tillaux fracture was first described by Paul Tillaux as an external rotation injury of the ankle, involving an avulsion fracture of the distal anterolateral tibia. This fracture can be easily overlooked on plain radiographs in the adult. A high index of suspicion for this type of fracture pattern along with the use of computed tomographic scanning can help confirm the suspected diagnosis, rule out other tibial injuries, and provide more information on the best course of action. Historically, Tillaux fractures have been more common in adolescents because of the open tibial epiphyseal plate. Once the epiphyseal plate fully closes, skeletal maturity is achieved, thus making it extremely unusual for the anterior tibiofibular ligament to cause an avulsion fragment of the distal anterolateral tibia. Because of how uncommon this type of fracture is in adults, it has rarely been reported in our literature. We reviewed the literature and present a case report of this rare fracture injury.

Peer vs. Self-Grading of Practice Exams: Which Is Better?

Practice exams are a type of deliberate practice that have been shown to improve student course performance. Deliberate practice differs from other types of practice, because it is targeted, mentally challenging, can be repeated, and requires feedback. Providing frequent instructor feedback to students, particularly in large classes, can be prohibitive. A possible solution is to have students grade practice exams using an instructor-generated rubric, receiving points only for completion. Students can either grade their own or a peer's work. We investigated whether peer or self-grading had a differential impact on completion of practice exam assignments, performance on practice exams or course exams, or student grading accuracy. We also investigated whether student characteristics mattered. We found that 90% of students took all practice exams or only missed one and that there was no difference on practice or course exam performance between the peer and self-graders. However, in the peer-grading treatment, students with lower incoming grade point averages and students identified as economically or educationally disadvantaged were less accurate and more lenient graders than other students. As there is no clear benefit of peer grading over self-grading, we suggest that either format can solve the challenge instructors face in giving frequent personalized feedback to many students.