Acute tibial tubercle avulsion fractures in children: Selective use of the closed reduction and internal fixation method

Abstract

Purpose Acute tibial tubercle avulsion fractures typically occur in adolescent boys involved in certain sports. All of the excerpted authors recommend open reduction and internal fixation (ORIF) as the only method to manage the displaced form of the injury. We attempted to select the optimal medical treatment of various types of this injury. The closed reduction and internal fixation (CRIF) method was selectively used. Methods During a period of 10 years (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), we treated 12 children with an acute injury to the tibial tubercle. Ogden's classification was used to describe the type of injury. Nine patients with a displaced fracture were treated surgically, using either the CRIF or ORIF methods. In cases of intraarticular fracture, the use of the CRIF method was tested. The suitability of the CRIF method was decided during manipulation of the fragments under an X-ray amplifier. Results According to Ogden's classification, three children were classified with type 1A, one with 1B, three with 2A, four with 3A, and one with 3B. In patients with the displaced extraarticular injury (types 1B and 2A), the ORIF method of treatment was necessary. In all but one case of intraarticular fracture (type 3A and 3B), the CRIF method was sufficient. Conclusions The authors recommend that, for displaced intraarticular Ogden's type 3A or 3B fracture, the CRIF method should be considered as a first choice.

Tibial tubercle fractures in children with intra-articular involvement: Surgical tips for technical ease

“…The incidence compared to all epiphyseal fractures has been reported to be 0.4-2.7% [1,2,5,6]. Tibial tubercle fractures often occur in athletic adolescents approaching physeal closure who have strong quadriceps muscles that lead to avulsion following eccentric contraction [7,8]. These fractures can present with marked displacement of the apophysis, intra-articular extension, and associated soft tissue injuries [1,5,[9][10][11][12][13].…”

The Avulsion Fracture of Tibial Tubercle in the Basis of Osgood-Schlatter Disease

“…Literatürdeki geniş kapsamlı çalışma-lardan olan; Frey ve ark. [7] yaptıkları çalışmada yirmi hastanın üçünde, Moiser ve Statinski [6] on dokuz hastanın ikisinde ve Pels ve Havranek [8] on iki hastanın birinde tanı öncesi OSH olduğunu bildirmişlerdir. Sunulan bu olguda da travma öncesinde tanı konulmamış olmakla birlikte hastada OSH'nı gösteren klinik ve radyolojik bulgular mevcuttu.…”

“…Deplasman varsa açık redüksiyon ve internal fiksasyon ile stabilize edilmelidir. Fiksasyonda seçilecek yöntem ise hastanın yaşı, kopan parçanın büyüklüğü ve cerrahın deneyimlerine göre belirlenmelidir [1,6,7,8]. Sunulan olguda, tibial tüberkülün deplase fraktürü ile birlikte parçalanmanın olduğu Ogden tip IIB kırık tespit edildiği için açık redüksiyon uygulanmıştır.…”

Imaging Review of Adolescent Tibial Tuberosity Fractures

“…The fracture line is present through the tubercle ossification center between the proximal tibia and tuberosity. Type IA indicates a minimally displaced or non-displaced fracture (Figure 1), while type IB (Figure 2) signifies anterior and proximal displacement or comminution [6,13]. A type IC designation was proposed to describe associated patellar tendon avulsions [12].…”

“…In addition, associated quadriceps or patellar tendon avulsions should be repaired to restore the extensor mechanism [1]. Several methods of fixation have been reported, but most authors recommend tension band wiring or cannulated screw fixation of the avulsed fragment ( Figure 13) [1,13]. Arthroscopy can also be considered if there is concern for concomitant internal derangement [2].…”