Acute Tibial Tubercle Avulsion Fractures

Abstract

A retrospective analysis of 18 patients with 19 acute tibial tubercle avulsion fractures was performed. Mean age at injury was 13 years 8 months. Mean follow-up time was 2 years 8 months. A group of four preadolescent patients ages 9 to 12 years at injury was identified. Participation in athletics, particularly basketball, resulted in 77% of fractures. There were one type IA, three type IB, two type IIA, six type IIB, two type IIIA, four type IIIB, and one type IV fractures. Fifteen fractures were treated with open reduction and internal fixation and four by closed reduction and cylinder cast immobilization. Three cases (15.7%) of extensor mechanism disruption were noted, two patellar tendon avulsions and one quadriceps avulsion. Final outcome was good in all patients regardless of fracture type or treatment. There were no complications.

Tibial tuberosity fractures in adolescents

“…Thus, genu recurvatum is usually not considered a complication often associated with this fracture due to the time in which the fracture occurs relative to physiologic physiodesis [2,4,7,19]. However, leg length discrepancy and/or genu recurvatum would most likely be associated with young physiologic age or improper surgical technique.…”

“…We also had one bilateral injury. There are 13 previous reports of bilateral injuries in the literature [19,[22][23][24][25]. There has not been a definitive correlation between Osgood-Schlatter disease and tibial tuberosity fractures, as suggested by Ogden and Southwick [16].…”

Physeal fractures about the knee

“…They may occur in isolation or be associated with additional injuries, such as patellar or quadriceps tendon avulsions, collateral or cruciate ligament tears, or lateral meniscal damage [6,53,54]. These fractures account for approximately 3 % of all proximal tibial fractures [53,55].…”

“…The developmental anatomy of the tibial tuberosity is unique in that the tibial physis closes from posterior to anterior, so the energy from the fracture can travel up the apophysis and then exit up into the joint [53]. It also closes proximal to distal which predisposes the tibial tubercle to avulsion injury, especially in older children, between 13 and 16 years of age (just before the tibial tuberosity ossification center fuses with the metaphysis by the age of 15 to 17 years) [19,53,55,56].…”

“…Patients classically report the sudden onset of knee pain during jumping activities, most often with onset during athletic participation, like basketball or football [6,55,58,63]. Mosier et al reported these fractures were the result of either a sudden contraction of the quadriceps during knee extension or passive flexion of the knee against rapid contraction of the quadriceps [55].…”