Imaging Review of Adolescent Tibial Tuberosity Fractures

Abstract

Adolescent tibial tuberosity injuries are infrequent fractures usually seen in physically active adolescent males. Powerful contraction of the knee extensors by sudden acceleration or deceleration of the quadriceps muscle can result in avulsion fractures of the tibial tuberosity apophysis. In late puberty, as the growth plate closes, it is transiently replaced by fibrocartilaginous elements. This transition causes a period of weakened tensile strength, which predisposes the tibial tuberosity to traction injury. Classification of tibial tuberosity fractures includes types I-V with added A and B subsets to types I, II and III. Multidetector computed tomography (MDCT) is a useful tool to more accurately classify complex, higher grade adolescent tibial tuberosity avulsion fractures when compared to plain film. This aids in preoperative planning and, therefore, results in improved treatment and management.

Tibial tuberosity maturation assessment by ultrasonography and screening for Osgood- Schlatter Disease in children and adolescent athletes: a cross sectional study

“…Common imaging modalities used to assess either the physiologic maturation or detect various pathologies of the tibial tuberosity include radiography, magnetic resonance imaging and ultrasound [6,10]. Although radiography is a valuable imaging tool for diagnosing traction injuries, such as avulsion fractures, it has some important limitations.…”

Anthropometry of the Black Adult Tibia: A South African Study

“…The resemblance of the tibial tuberosity to that of an inverted-U, seen in 100% of dry tibiae in the current study, may serve as the standard around which fracture patterns of avulsion injuries of the tuberosity may be accurately evaluated (Chitkara et al, 2013).…”

Rehabilitation of Watson-Jones proximal tibial avulsion injury in elite academy level football: A report of two separate cases in one season

“…It is reported that proximal tibial avulsion fractures occur more frequently in adolescent males, who are both athletic and muscular [4]. Physiologic physiodesis occurs at a later age in males, which can place the tubercle at greater risk of injury [5]. This, combined with males being larger, heavier with stronger quadriceps, places greater strain through the tibial tubercle, which may predispose to avulsion type injury [4].…”