Tibial tubercle fractures in children with intra-articular involvement: Surgical tips for technical ease

Abstract

We speculate that patients who sustain a tibial tubercle avulsion fracture types III or V will likely have intra-articular pathology, specifically capsular avulsion or coronary ligament disruption. By utilizing suture anchors, our technique emphasizes renewing the anatomic articular environment to ensure better long-term results and maintaining these active individuals in sports.

Fracture of tibial tuberosity in an adult

“…Some studies correlate avulsion of the tibial tuberosity with associated injuries of the knee6 10–12 as meniscal tears, collateral ligaments ruptures, capsule avulsion and intra-articular fractures, but we also could not find any on the clinical examination. The fracture of the tibial tuberosity in adults is usually due to a complication of anterior cruciate ligament reconstruction with autologous patellar tendon graft 13.…”

“…The usual mechanism of avulsion of the tibial tuberosity is a sudden contraction of the quadriceps during knee extension or passive flexion of the knee against rapid contraction of the quadriceps 5. It happens on jumping or stabilising the knee in flexion 6. However, the direct trauma to the knee due to a fall from height could produce the fracture as shown.…”

“…In our opinion, when there is a trauma knee, radiography should always be the first imaging test to be requested, but fractures extended to the joint and fragmented should be evaluated with CT 6 11. When soft tissue-associated injuries are suspected, MRI can also help the diagnostic 16…”

Extensor Mechanism Injury in the Pediatric Population—A Clinical Review

“…18 Multiple studies now recommend that computed tomography (CT) be performed if there is suspicion for articular involvement. 13,15,19 Fracture types III, IV, and V have been found to have increased risk of significant intra-articular involvement and therefore should suggest the clinician the possible need for CT. 15,19 Non-operative Management and Indications for Operative Management Treatment has not been standardized leaving decisions for operative versus non-operative treatment as well as the modality for surgical fixation largely up to the clinician. Freedom in treatment is likely a combination of the general scarcity of fracture occurrence and the realization that most of these fractures do well.…”

“…For associated meniscal injuries seen in type III fractures, Hosalkar and colleagues describe a method using suture anchors to restore the meniscal-articular relationship. 19 Anchors are placed in the epiphysis just adjacent to the fracture site, and once osteosynthesis is achieved, the coronary ligaments are grasped with the suture and tied down to reduce the menisci.…”