Tibial tubercle avulsion fractures in school sports injury: A case report

Abstract

Highlights Most injuries in school occur during sport. Avulsion fractures of the tibial tubercle are uncommon school sports injuries. X-ray is the key to diagnosis. Then CT scan is needed to evaluate the fracture extension to the articular joint. Many cases are misdiagnosed and progress to recurvatum deformity especially in open physis individuals after neglected tibial tuberosity fractures. These injuries cause significant disruption to school and sport, but fortunately, complications are rare and functional recovery is usually complete.

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

“…This typically applies to type II-V fractures [3,6,10,15]. There are several surgical options, including ORIF with cannulated screws or K-wires, closed reduction and percutaneous pinning, arthroscopy or soft tissue repair [1][2][3]5,7,[10][11][12][13]15]. Cancellous partially threaded screws are recommended for internal fixation as they allow greater compression at fracture site, although K-wires may be useful in younger children [1].…”

“…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].…”

“…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].…”

“…There are a few classification systems for TTAFs. The first was introduced in 1976 by Watson-Jones [1,3,5,10,12,15], although the most commonly used nowadays is a modification of the former presented by Ogden and colleagues [13] in 1980. Besides types I, II, and III of the original Watson-Jones classification, Ogden added subtypes A and B to include comminution and displacement of the fracture fragment.…”

“…Tibial tubercle avulsion fractures (TTAFs) are uncommon injuries during childhood and adolescence, depicting around 3% of all proximal tibia fractures and not even 1% of all epiphyseal lesions. They tend to occur mainly in young male of age between 12 and 16 years old [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. This type of injury occurs when the tensile force exerted by the patellar tendon on the tibial tubercle is greater than growth plate strength [4,8,12,13,15,16].…”