Tibial tubercle avulsion fracture in adolescents: 9 cases and review of the literature

Abstract

Objective To review the clinical outcome of tibial tubercle avulsion fracture in adolescents.Methods This was a retrospective analysis of a consecutive series of 9 children with tibial tubercle avulsion fracture managed in our institution between January 2003 and June 2008.All patients were boys,with an average age of 14.6 years(range 12.8-16.3).The average weight was 66 kg (range 50-89)and the average height was 173cm (range 165-180).The avulsion occurred after a jump or on landing 8 children-The fracture occurred during basketball (n=6),Soccer (n=1),High jump (n=1),hurdle jump (n=1).One was diagnosed with Osgood-Schlatter disease and two patients presented symptomatic ipsilateral or contralateral anterior tibial apophysitis before the accidents.There were three patellar ligament avulsion and no meniscal injury.According to the Ogden's and Ryu and Debenham's modified classification system,there were 1 type I (11%);2 type Ⅱ (22%);4 type Ⅲ(44%),2 type Ⅳ (22%) injuries.Three patients had close reduction under anesthesia and cvlinder cast immobilization.Six patients underwent open reduction and internal fixation,including 3 cancellous screws,2 Kirschner wires and screws,and 1 absorbable screws.Three patients underwent knee joint exploration.Cast immobilization was maintained for six weeks in both groups.The functional outcome was assessed at last follow-up.Results One patient was lost during follow-up.Eight patients were followed up for a mean of 27.5 months (range 6-66).The functional outcome was excellent in all patients according to the Mosier's scoring system for the motion function.Two of 8 patients had quadriceps atrophy,one had infrapatellar hypoesthesia.There were no compartment syndrome,deformity ol knee joint,nonunion,genu recurvatum,infection,refracture or leg length discrepancy.Conclusions Tibial tubercle avulsion with minimal displacement can be treated conservatively.The displaced fracture generally require open anatomic reduction and internal fixation.The outcome is generally good. Key words: Tibial fracture; Fracture fixation,intramedullary; Casts,surgical