Simultaneous bilateral tibial tubercle avulsion fracture in a male teenager: case report and literature review

Abstract

Case report.

Tibial Tubercle Avulsion Fracture with Multiple Concomitant Injuries in an Adolescent Male Athlete

“…The tibial tubercle represents the most inferior aspect of the extensor mechanism, and adolescents are at increased risk of injury due to the relative weakness of the physis compared to the tendon insertion [ 7 ]. The tibial tubercle ossifies in a systematic mechanism from the superior aspect of the epiphysis to the inferior margin [ 3 ]. The primary goal in treating this injury is to restore the extensor mechanism and, if the joint space is involved (as seen in types III and IV), to restore the integrity of the joint surface [ 10 ].…”

“…Tibial tubercle avulsion fractures occur in 0.4–2.7% of epiphyseal injuries and less than 1% of physeal injuries [ 1 , 2 ]. This injury is most commonly seen in adolescent males during athletic activity but may also be associated in patients with osteogenesis imperfecta and Osgood-Schlatter disease [ 3 , 4 ]. Strong contraction of the quadriceps femoris muscle during leg extension causes failure of the physis at the patellar tendon insertion [ 5 ].…”

Bilateral Simultaneous Tibial Tubercle Avulsion in an Adolescent Football Player with Previous Bilateral Osgood–Schlatter Disease

“…Tibial tubercle avulsion fractures are a very uncommon injury, accounting between 0.4 and 2.7% of all epiphyseal injuries [1]; however, the prevalence is uncertain due to the variations in the identification of this injury pattern, since many authors include them within the proximal epiphysiolysis of the tibia and others as a fracture-avulsion, and even the well-localized lesions are sometimes interpreted as variants of a lesion of Osgood–Schlatter [2]. Bilateral lesions are extremely rare with only 20 cases described in the literature [3]. They occur more frequently in male adolescents and during sport activities that require jumping and sprinting, such as football or basketball [4].…”

“…It can occur in two situations: sudden knee flexion against a contracted quadriceps muscle and, as in the present case, excessive contraction of the quadriceps during extension of the knee, both of which are common during sport activities [6]. Activities such as jumping and sprinting that require landing can lead to knee locking in extension and thus create the necessary biomechanical conditions for this type of fracture to occur [3]. Several classification systems have been described to categorize these fractures, which can be confusing to the reader given the use of subcategories [4].…”

“…Nonunion, malunion, infection, and pain have been reported. All complications associated with TT avulsion fractures are very uncommon [3].…”