Bilateral tibial tubercle avulsion fractures: A pediatric orthopedic injury at high risk for compartment syndrome

Yue, Ivan; Hurst, Nicole; Peterson, Jonathan B.; Kanegaye, John T.; Auten, Jonathan D.

doi:10.1016/j.ajem.2019.05.033

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…Anterior tibial avulsion may be associated (1-2%) with collateral and cruciate ligament injuries, meniscal tears, patellar or quadriceps tendon tears, and joint cartilage lesions, especially in the case of intra-articular involvement. Moreover, Ivan Yue et al [18] report that compartment syndrome of the anterior compartment may occur in up to 10-20% of cases [18].…”

Section: Discussionmentioning

confidence: 99%

“…One hundred and twenty seven articles were found and the latest complete review of the literature has conducted by Roy and Nag [5] in 2013 reporting twenty-one cases. Since then, we can add one case by Khoriati et al [17], one case by Nicolini et al [9], one case by Yue et al [18], and four cases by Fernandez Fernandez et al [19]; therefore, amounting to twenty eight reported cases. Our two cases would be the 29th and 30th reported and the first two documented in Switzerland.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Bilateral Avulsion of Tibial Anterior Tubercle in Adolescent: Two Case Reports and Narrative Review of the Literature

Giunchi

González

Odorizzi

et al. 2023

Case Reports in Orthopedics

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Fractures of the anterior tibial tuberosity are uncommon, ranging from 0.4% to 2.7% of all epiphyseal lesions reported. Bilateral sequential fractures are even rarer, with less than twenty-eight cases described to date and, as such, there is very little consensus data on their treatment as a whole. We report the first two documented cases of bilateral tibial tuberosity avulsions of the anterior tubercle in Switzerland, treated by open reduction and internal fixation. Both cases were 14-year-old healthy males with no previous medical history, who both suffered extra-articular fractures after falling from a height. The first case was treated in 2012 with a four-year long clinical follow-up and full recovery. The second, treated in 2019, was clinically followed for one year with a complete recovery and has returned to sporting activity at a pre-injury level. Due to the rarity of the condition, a lack of consensus on the optimal therapy, we believe the documentation of these two cases treated by the same team may be of clinical relevance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Simultaneous Bilateral Avulsion of Tibial Anterior Tubercle in Adolescent: Two Case Reports and Narrative Review of the Literature

Giunchi

González

Odorizzi

et al. 2023

Case Reports in Orthopedics

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“…However, one barrier to treatment of tibial tubercle fractures in an ambulatory setting, with no need for perioperative hospitalization, is concern regarding the development of compartment syndrome. 17 – 19 The tibial tubercle is closely associated with the fascia of the anterior compartment near a fan-shaped group of vessels originating from the anterior recurrent tibial artery, 20 and these vessels are prone to bleeding into the anterior compartment when damaged. 21 Elevated pressures in posterior and lateral compartments of the knee have also been described in association with tibial tubercle fractures.…”

Section: Introductionmentioning

confidence: 99%

“… 22 The reported incidence of suspected compartment syndrome is as high as 10%–20%, 8 , 23 with many surgeons electing to perform prophylactic fasciotomy at any sign of a firm anterior compartment. 10 , 19 However, actual confirmed instances of compartment syndrome are rarer and are usually associated with more extensive injuries. 24 – 27 A recent systematic review of 336 tibial tubercle fractures found a 4% incidence of preoperative compartment syndrome and a 0% incidence of postoperative compartment syndrome.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory surgical management of most displaced tibial tubercle fractures in children is safe and efficient

Zukotynski,

Brown,

Hori

et al. 2023

Journal of Children's Orthopaedics

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Purpose: The purpose of this study is to compare the outcome of patients with displaced tibial tubercle fractures treated surgically who spent one or more nights in the hospital after surgery with that of patients treated in an ambulatory setting with no perioperative hospitalization. We hypothesized that tibial tubercle fractures have a low rate of complications and that most patients do well without an overnight hospital stay for observation. Methods: We retrospectively reviewed all pediatric tibial tubercle fractures treated operatively by a single surgeon over a 13.5-year period. Fractures treated in an inpatient setting, defined as at least one night of overnight hospitalization postoperatively, were compared with fractures treated in an ambulatory setting with no perioperative hospitalization. Results: Seventy-one fractures in 70 patients were analyzed. All fractures were treated with open reduction and internal fixation with unicortical screws. Thirty-five fractures (49.3%) were fixed in an ambulatory setting, while 36 (50.7%) were inpatient. There were no significant differences between inpatient demographics (age, gender, body mass index, fracture type). Average operative time was significantly longer in the inpatient group compared with the ambulatory group (97.8 min versus 58.8 min, p < 0.001). There was no significant difference in the incidence of complications between inpatient and ambulatory groups (25.0% versus 11.4%, p = 0.22). No cases of compartment syndrome were noted. Conclusion: Ambulatory surgical treatment of select tibial tubercle fractures with same-day discharge is safe and efficient. Not all patients with surgically treated tibial tubercle fractures need to stay overnight in the hospital.

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Risk of Acute Compartment Syndrome in Pediatric Patients With Tibial Tubercle Avulsion Fractures: A Retrospective Review

Bergen,

Vutescu,

McKinnon

et al. 2024

Journal of Pediatric Orthopaedics

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Objective: Tibial tubercle avulsion fractures (TTAFs) represent 0.4% to 2.7% of pediatric physeal injuries. These injuries are thought to confer a risk of acute compartment syndrome (ACS), and these patients are often admitted for compartment monitoring and, in many cases, undergo prophylactic fasciotomy. This study sought to review our institution’s experience with TTAF and associated compartment syndrome in pediatric patients. Methods: All patients aged 8 to 18 years with TTAF at our institution from January 1, 2017 to January 1, 2023 were retrospectively reviewed. Patient demographics, injury mechanism, fracture morphology, and postinjury course were reviewed. ACS was diagnosed by clinical exam or necessitating therapeutic compartment fasciotomy. Results: A total of 49 TTAFs in 47 patients were included in the final analysis. The mean age was 14.5 ± 1.2 years (range: 11 to 17), and males were significantly older than females (14.6 ± 1.1 vs 13.3 ± 1.3 y, P = 0.01). The average body mass index was 27.1 ± 7.0, and males had a significantly lower body mass index than females (26.3 ± 6.5 vs 34.1 ± 8.5, P = 0.03). Basketball was the most common mechanism of injury (49%), followed by soccer (13%), football (11%), trampoline (6%), fall (6%), jumping (4%), lacrosse (4%), running (4%), and softball (2%). The Ogden fracture types were as follows: I: 10%; II: 16%; III: 41%; IV: 24%; V: 8%. Thirty-four patients (69%) were admitted to the hospital for at least one night after presentation. Forty-six (96%) underwent surgical fixation an average of 3.5 days after injury. No patients developed ACS during their post-injury or postoperative course. Three patients underwent the removal of hardware. No other complications were observed. The average follow-up duration was 238 days. Conclusions: The results of this study suggest that the risk of ACS in pediatric patients with TTAF may be small enough to allow for same-day discharge after diagnosis or operative management in patients deemed to be sufficiently low risk by clinical judgment. Level of Evidence: Level III—retrospective comparative study.

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Bilateral tibial tubercle avulsion fractures: A pediatric orthopedic injury at high risk for compartment syndrome

Cited by 3 publications

References 14 publications

Simultaneous Bilateral Avulsion of Tibial Anterior Tubercle in Adolescent: Two Case Reports and Narrative Review of the Literature

Simultaneous Bilateral Avulsion of Tibial Anterior Tubercle in Adolescent: Two Case Reports and Narrative Review of the Literature

Ambulatory surgical management of most displaced tibial tubercle fractures in children is safe and efficient

Risk of Acute Compartment Syndrome in Pediatric Patients With Tibial Tubercle Avulsion Fractures: A Retrospective Review

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