Abstract
Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern. Case Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle. Discussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries.
Highlights
DiscussionA relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture
IncidenceTibial tuberosity avulsion fractures are extremely rare fracture patterns, with reported incidence rates of 0.4% to 2.7% of all epiphyseal injuries,
Discussion: a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities
Summary
Tibial tubercle avulsion fractures are associated with a wide variety of additional injuries and the repair has shown a few common complications. In one study that comprised of 336 tibial tubercle avulsion fractures in adolescent patients, these concomitant injuries were shown at rates of (2%) patellar or quadriceps tendon avulsions, (2%) meniscal tears, (1%) increased ligamentous laxity, and (4%) compartment syndromes[14]. While there seems to be some latitude regarding the approach the clinician may take in treating these injury types (Ia, IIIa, and IIIb), it is recommended by Pesl and Havranek[10] that openreduction with internal-fixation is the only appropriate treatment for the extra-articular form of the injury (Ib and IIa) due to either large displacement of a small tibial tubercle fragment or intervening soft tissue making closed-reduction unfeasible. They showed that there was no statistically significant difference among fracture types in regard to return to preinjury activities or range of motion, with fracture union reported in all 23 articles with a 99% healing rate
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