Fracture of the anterior tibial tuberosity in children

Abstract

Fractures of the anterior tibial tuberosity during childhood are an infrequent pathology (around 3% of all proximal tibial fractures), but the incidence of this injury has risen over recent years, likely due to the increased involvement of this age group in sports activities. This fracture is more commonly seen in children 12–14 years old. It is vital to identify the anatomical structures associated with this type of fracture, along with the pathophysiological mechanisms involved. Treatment includes non-operative and operative options, with the goal of achieving articular congruency, restoring the extensor mechanism function, and avoiding damage to the proximal tibial physis. Understanding the management of this fracture, and the complications that might arise, is critical. The provision of an appropriate clinical management plan and the avoidance of complications are vital in the prevention of disability. Cite this article: EFORT Open Rev 2020;5:260-267. DOI: 10.1302/2058-5241.5.190026

Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life

“…Fractures with intra-articular involvement, such as types III and IV, are more likely to be associated with meniscal injuries, and further study using MRI is advisable [1][2][3]7,15]. Ligament injuries are unusual [1,3,13].…”

“…Arthroscopy may be advantageous to assess joint surface congruency and treat any associated meniscal injuries. Yet, it should be kept in mind that this method of treatment is technically challenging and increases the risk of compartment syndrome [1,3,10]. Postoperatively, the knee should also be immobilized in extension and patients should be nonweight bearing for about 4-6 weeks, after which they should start progressive strengthening of the extensor mechanism and a functional rehabilitation program before resuming sports activity [1][2][3]5,6,10,12,15].…”

“…The proximal tibia has two secondary ossification centers: the epiphyseal ossification center (which appears in the first weeks of life and contributes to growth) and the tibial tubercle ossification center (that usually begins to develop between 7 and 12 years old and is located where the patellar tendon inserts) [1][2][3]10,13,15]. Around 14 years of age in girls and 16 years in boys these two centers of ossification start to fuse with each other and with the metaphysis, in the central zone first.…”

“…TTAFs can be managed either conservatively or surgically. However, in both cases it is mandatory to preserve a functional knee extensor apparatus, obtain anatomic reduction of the articular surface and manage associated injuries [1][2][3]7,[10][11][12]15]. There is a low incidence of complications and functional outcomes are generally great, regardless of the type of treatment [1][2][3][4][5][6][7][10][11][12][13][14].…”

“…However, in both cases it is mandatory to preserve a functional knee extensor apparatus, obtain anatomic reduction of the articular surface and manage associated injuries [1][2][3]7,[10][11][12]15]. There is a low incidence of complications and functional outcomes are generally great, regardless of the type of treatment [1][2][3][4][5][6][7][10][11][12][13][14]. Over 97% of patients acquire complete knee range of motion and return to preinjury level of sports activity [1,3,4,[6][7][8][9]11,13,14].…”