Ipsilateral Patellar Distal Pole and Tibial Tubercle Avulsion Fractures in an Adolescent: A Case Report and Review of the Literature.

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We present a case of simultaneous ipsilateral patellar distal pole and tibial tubercle avulsion fractures in an adolescent patient. While each entity is well documented when occurring in isolation, to the best of our knowledge, this is the first case in the medical literature of both injuries occurring simultaneously. The patient and his mother were informed that data concerning the case would be submitted for publication, and they provided consent. A fourteen-year-old healthy adolescent (with a body mass index of 23 kg/m2) presented to the emergency department following a fall forward onto a hyperflexed left knee. Immediate symptoms were pain in the knee and inability to bear weight. There was no relevant past or family history, and he had no prior history of fractures. Prior to the injury, he had been healthy with no history of pain in the anterior aspect of the knee or Osgood-Schlatter disease. On examination, there was a large effusion in the left knee, with tenderness at both the proximal and distal ends of the patellar tendon. The overlying skin was intact. Despite adequate analgesia, the patient was unable to perform a straight leg raise or extend the knee. The knee was stable in the coronal and sagittal planes. Radiographs (Figs. 1-A and 1-B) demonstrated an opacity distal to the patella, keeping with a sleeve-type avulsion fracture of the distal pole. The Insall-Salvati ratio was 1.8. The knee was placed in a temporary splint and surgery was recommended. Preoperative anteroposterior ( Fig. 1-A ) and cross-table lateral ( Fig. 1-B ) radiographs of the left knee. Both radiographs show an opacity distal to the patella, but the tibial tubercle appears relatively normal. Fig. 1-A Fig. 1-B The patient was taken to the operating room the following morning, and an arthrotomy was performed via a midline incision. Both medial and lateral retinacular disruption were noted. The distal patellar avulsion was evaluated; there was no substantial soft-tissue dissection, but we noted a multifragmentary extra-articular fracture …