Lessons learnt from managing an avulsion fracture of the tibial tubercle extending into the tibial physis

Abstract

SUMMARYAcute avulsions of the tibial tubercle apophysis are uncommon, with reported incidence of 0.4-2.7% of all physeal injuries. In our case the extent of the injury was not realised at first presentation and initial internal fixation was attempted. At first outpatient follow-up, repeat radiographs indicated the fracture was not reduced and further CT imaging requested. The threedimensional CT reconstructed images provide considerably more information on the fracture pattern and retrospectively these may have been helpful during the initial procedure. Therefore we would recommend obtaining a preoperative CT scan if extension of the fracture into the tibial physis is suspected. During the second procedure arthroscopy was tried to aid fracture reduction, but visualisation of the anterior articular surface under the anterior horns of the menisci was difficult through the anterior portals with a standard 30°a rthroscope and we further recommend having a 70°s cope available to ensure optimal visualisation. BACKGROUND

A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs

“…44 Swelling and deformity may be present in the area surrounding the tibial tubercle and plain radiographs should be taken to confirm the diagnosis. 44,46 The Watson-Jones classification divides this injury into 3 types, depending on the amount of involvement of the proximal epiphysis and degree of displacement (Table 2). 3,44 Treatment should restore the anatomy of the displaced fragment, extensor mechanism alignment, and joint congruency.…”

“…46 The ORIF is recommended when severe displacement or comminution is present at the physis. 46 Surgery should restore the extensor mechanism and joint congruency. 46 Use of preoperative CT scans and intraoperative arthroscopy are also recommended to better visualize the fracture pattern (Figure 9).…”

“…46 Surgery should restore the extensor mechanism and joint congruency. 46 Use of preoperative CT scans and intraoperative arthroscopy are also recommended to better visualize the fracture pattern (Figure 9). 46 Tibial spine.…”

“…46 Use of preoperative CT scans and intraoperative arthroscopy are also recommended to better visualize the fracture pattern (Figure 9). 46 Tibial spine. Closed reduction with casting or splinting in extension or slight flexion (20°-30°) can be done for less severe tibial spine avulsions.…”

“…3,44 It accounts for approximately 0.4% to 2.7% of all physeal injuries. 45,46 The patient will have severe pain on the anterior aspect of the knee and, likely, be unable to walk and actively move the knee joint. 44 Swelling and deformity may be present in the area surrounding the tibial tubercle and plain radiographs should be taken to confirm the diagnosis.…”