Tibial Tubercle Avulsion Fractures Research Articles

Late Manipulation under Anesthesia after Total Knee Arthroplasty: Improved Range of Motion and a Low Complication Rate.

The purpose of this study was to evaluate outcomes of late manipulation under anesthesia (MUA) for stiffness performed from ≥12 weeks to more than a year after primary total knee arthroplasty (TKA). A total of 152 patients receiving MUA ≥12 weeks after primary TKA from 2014 to 2021 were reviewed. The primary outcome measured was change in range of motion (ROM). We tracked intraoperative complications and the need for repeat MUA or open procedure for continued stiffness after initial MUA. Three subgroups were analyzed: Group 1 included 58 knees between 12 weeks and 6 months after TKA, Group 2 included 44 knees between 6 and 12 months after TKA, and Group 3 included 50 knees ≥12 months after TKA. Analysis included descriptive statistics and univariate analysis, with α <0.05. Groups 1 to 3 all significantly increased their overall ROM by 20.9, 19.2, and 22.0 degrees, respectively. All groups significantly increased their flexion and extension from preoperatively. Group 1 had one intraoperative supracondylar femur fracture (1.7%) requiring open reduction and internal fixation, and five patients required repeat MUA or open procedure (8.6%). Group 2 had no intraoperative fractures, and five patients required repeat MUA or open procedure (11.4%). Group 3 had one intraoperative tibial tubercle avulsion fracture managed conservatively (2.0%) and one repeat MUA (2.0%). Late MUA resulted in significantly improved ROM in all groups. ROM improved more as the time from index TKA increased, although statistically insignificant. Repeat MUA or open procedure rate decreased with MUA ≥12 months from TKA, although statistically insignificant. The overall intraoperative fracture risk was 1.3%.

Tibial tuberosity fracture in adult as an unusual pattern of injury

Tibial tuberosity avulsion is an uncommon fracture in adults, such lesions typically seen in adolescent male with well-developed quadriceps, ligaments when they are stronger than growth plate. We described a case of 51-year-old gentlemen had direct trauma to left knee, no risk factors were identified, not able to walk, difficulty in straight leg raise test, radiograph of left knee showed tibial tuberosity avulsion fracture. The fracture was treated with open reduction and internal fixation, f/u with successful rehabilitation which results in good range of motion and excellent function at knee joint. The aim of study is present unusual and rare case of tibial tuberosity Avulsion fracture in adult, early diagnosis, surgical mode of treatment, post-surgery rehabilitation and possible complications.

Anterior Cruciate Ligament Reconstruction in Tibial Eminence Avulsion Fracture: A Case Series

Introduction: Ruptures of the anterior cruciate ligament (ACL) are common orthopedic injuries, especially among patients participating in sports. Anterior cruciate ligament (ACL) avulsion fracture or tibial eminence avulsion fracture is a type of avulsion fracture of the knee. This article describes several cases of ACL rupture management with eminence avulsion. Case report: This case series describes 3 cases of ACL tear with eminence avulsion. The first patient was a 31-year-old female with right knee pain since 6 months ago after a traumatic fall from a motorcycle. The second patient, a 16-year-old girl with a history of bending her legs inward during exercise. The third patient is a 49-year-old female with a history of accidents and complaints of knee pain. All three patients found ACL tear accompanied by an avulsion fracture on the tibial eminence and then undergo ACL reconstruction. Discussion: The most common mechanism of trauma, which leads to a disruption of ACL, is a trauma forcing the knee in hyperextension combined with valgus-external rotation. At times, these lesions can occur in adults; in this instance, the main cause is high-energy trauma, such as road accidents. Based on case reports and previous research, the management approach in this case is still debatable in children and adults and requires a specific approach in each case. Conclusion: The management of ACL reconstruction in patients with tibial eminence avulsion involvement is still a challenge for orthopedic surgeon. Given the rarer cases, a different approach is needed in young and adult cases. Each case requires proper management to improve the patient's functional outcome and their quality of life. Keywords: anterior cruciate ligament reconstruction, avulsion fracture, tibial eminence avulsion

A Rare Case Report of an Isolated Avulsion Fracture of Gerdy's Tubercle

We report a case of en bloc avulsion fracture of tibial tuberosity and Gerdy's tubercle. A 40 -year-old male suffered from an acute pain in his left knee after a motorcycle accident. Simple radiographs showed an avulsion of the tibial tuberosity. Confirmed by CT scans. MRI evaluation revealed no intra-articular associated pathology. Open reduction and internal fixation with 1 screws were performed under antero-lateral approach to expose the Gerdy's tubercle with ITB. At 2 months postoperative, he could walk and complained of no difficulty in activities on daily living with full range-of-motion of the knee. We believe that the injury was caused by violent contraction of the tensor fascia lata or gluteus maximus. Preoperative planning including the determination of the extent of fracture and recognition of concomitant injury is a prerequisite for appropriate treatment.

A Technique for Arthroscopic Fixation of Tibial Eminence Avulsion Fractures: A Physeal-Sparing Construct With All-Suture Anchor Bridge Fixation

Arthroscopic or open surgical treatment is indicated for displaced tibial spine fractures to obtain anatomic reduction and restore the functionality of the anterior cruciate ligament. Numerous open and arthroscopic techniques for the treatment of tibial spine fractures have been described. The purpose of this technical note is to describe a minimally invasive arthroscopic physeal- and ligament-sparing surgical technique using knotless all-suture anchors to provide stable bridge fixation over displaced tibial spine fractures.

Suture anchor fixation of displaced tibial eminence avulsion fracture in children

Abstract Background Avulsion fractures of the tibial eminence during childhood are infrequent yet significant knee injuries. Given that the injury is equivalent to a rupture of the anterior cruciate ligament. The treatment strategy necessitates anatomic reduction to reestablish joint stability and reduce the risk of anterior impingement and flexion deformity. The aim of the study was to evaluate short-term results of arthroscopyassisted suture anchor fixation of tibial eminence avulsion in children. Methods This study included 11 injured children with type III avulsion tibial eminence. The average age was 8.55 years. The study included nine boys and two girls. The mechanism of trauma was bicycle accident in seven children, twisting injury in two children, falling downstairs in one child, and jumping from a height in one case. Results All patients were able to return to their everyday activities within 6 months following the injury. The range of motion at the end of follow up was full in 10 (90.9%) patients and functional range in one (9.1%) patient. The knee stability was excellent by clinical examination. Conclusion The successful application of this approach in preserving knee function following type III avulsion tibial eminence in pediatric patients has been demonstrated.

Four Cases of Avulsion Fracture of the Anterior Tibial Tuberosity

This work is an observational study focusing on 4 cases of avulsion fracture of the anterior tibial tuberosity, collected between 2020 and 2022 at the orthopedic and trauma surgery department of Fattouma Bourguiba Hospital in Monastir in Tunisia. The aim of this work is to study the epidemiological, clinical, radiological, therapeutic and evolutionary aspects of this pathology. The patients in our series, all male, were aged between 14 and 17 years. Three of them had Osgood Schlatter syndrome preceding the lesion. The clinical presentation was, in all cases, a swollen knee, with a deficit of active extension, a high patella, and pain on palpation of the ATT. X-Ray showed in lateral Knee view: 2 cases classified Ogden IIIB, one case Ogden IB and one case Ogden IIB. All our patients were treated surgically by screwing in one case, cerclage in two cases, and by screwing plus cerclage in one case. The progress was considered satisfactory at 12 weeks postoperative follow-up.

Risk factor analysis for tibial tubercle avulsion fractures in children.

Tibial tubercle avulsion fractures (TTAFs) are rare in children, particularly bilateral TTAFs. This study aimed to elucidate the associating factors of TTAF, and compare the risk factor profiles of unilateral and bilateral injuries, thus provide clinical theoretical basis for reducing the occurrence of TTAFs. TTAF paediatric patients who were hospitalized between April 2017 and November 2022 were retrospectively analysed. Children who presented for physical examination during the same period were randomly selected, and were age- and sex-matched as controls. A subgroup analysis based on endocrine function was also performed. A risk factor analysis for bilateral TTAF was performed as well. Data were collected via medical records and a questionnaire. All variables were assessed for association with TTAF using univariate and multiple logistic regression analyses. A total of 64 TTAF patients and controls were respectively included. Multivariate analysis demonstrated BMI (P = 0.000，OR = 3.172), glucose (P = 0.016，OR = 20.878), and calcium (P = 0.034，OR = 0.000) as independent associating factors of TTAF. Subgroup analysis showed significant differences in oestradiol (P = 0.014), progesterone (P = 0.006) and insulin levels (P = 0.005) between the TTAF and control groups. Bilateral TTAF was found to significantly associate with a history of knee joint pain (P = 0.026). High BMI, hyperglycaemia, and low calcium levels were found as independent risk factors for TTAF in children. In addition, decreased oestradiol, elevated progesterone, and insulin resistance were identified as potential risk factors for TTAF. A history of knee pain may be suggestive of bilateral TTAF.

Does Skeletal Maturity Predict the Pattern of Tibial Tubercle Avulsion Fracture?

Proximal tibial physeal development and closure is thought to relate to tibial tubercle avulsion fracture (TTAF) patterns. Prior work has yet to formally evaluate the relationship between skeletal maturity and fracture pattern. Using 2 knee radiograph-derived skeletal maturity assessments [growth remaining percentage (GRP) and epiphyseal union stage], we examined their association with TTAF injury patterns using the Ogden and Pandya fracture classifications. We hypothesized that different TTAF injuries would occur during unique periods of skeletal development. Pediatric patients sustaining TTAFs treated at a single institution (2008-2022) were identified using diagnostic and procedural coding. Demographics and injury characteristics were collected. Radiographs were reviewed to assign epiphyseal union stage, Ogden and Pandya classifications and for measurements to calculate GRP. Univariate analyses examined the relationship between injury subgroups, patient demographics, and skeletal maturity assessments. Inclusion criteria identified 173 patients with a mean age of 14.76 (SD: 1.78) and 2.95% (SD: 4.46%) of growth remaining. The majority of injuries were classified Ogden III/Pandya C. Most (54.9%) were the result of the axial loading mechanism. Ogden groups showed no significant differences across all patient characteristics studied including age and GRP. With the exception of Pandya A fractures, we did not identify a direct relationship between GRP, age, and Pandya groups. Epiphyseal union stage differed for Pandya A and D groups. A predictable pattern in TTAF characteristics across skeletal (GRP), epiphyseal union, or chronologic age was not identified in this study. Distal apophyseal avulsions (Ogden I/II and Pandya A/D) occurred across a broad chronologic and skeletal age range. No differences were identified in epiphyseal or posterior extension (Ogden III/IV and Pandya B/C) injuries. Although differences in age and GRP were identified among Pandya As, this is thought to be due to the degree of skeletal immaturity that is a prerequisite for differentiation from Pandya Ds. Level III-retrospective cohort study.

Biomechanical comparison of one pin versus two pin fixation in a canine tibial tuberosity avulsion fracture model.

To determine whether one larger or two smaller diameter pins used for tibial tuberosity avulsion fracture (TTAF) stabilization provides greater axial tensile strength and stiffness when subjected to monotonic mechanical load to failure in normal skeletally mature canine cadavers. Paired ex vivo biomechanical study. Eleven pairs of adult cadaveric dog tibias. Twenty-two tibias from 11 dogs were collected to model a TTAF. Each limb of a pair was randomly assigned a one or two-pin fixation. Tibias were subjected to monotonic, axial load to failure. Fixation stiffness, strength, and pin insertion angles were analyzed with parametric testing. Significance was set at p < .05. The mean strength of the single-pin fixation was 426.2 ± 50.5 N compared to two-pin fixation at 639.2 ± 173.5 N (p = .003). The mean stiffness of the single-pin fixation was 57.3 ± 18.7 N/mm and the two-pin fixation was 71.7 ± 20.5 N/mm (p = .029). The normalized ratio between one and two-pin fixation had a mean stiffness of 68% ± 25.8% and strength of 82.8% ± 24.6%. In an ex vivo cadaveric TTAF model, vertically aligned two-pin fixation offers greater strength and stiffness when compared to a single-pin fixation. When repairing TTAF, surgeons should aim to apply two vertically aligned pins rather than a single pin for greater strength and stiffness.

Systematic review regarding treatment of tibial tuberosity avulsion fractures in young dogs

Tibial tuberosity avulsion fractures represent a small proportion of proximal tibial fractures in dogs. We distinguish between different types of this trauma. This disease is commonly encountered in young and skeletally immature animals. In the past, dogs with tibial tuberosity avulsion fractures were not treated, which resulted in chronic lameness. At present, various therapeutic methods are available for managing this disease. The aim of this article was to present the therapeutic protocols for managing tibial tuberosity avulsion fractures in dogs. The present article reviews the data regarding the treatment of tibial tuberosity avulsion fractures in dogs. Many veterinarians are reluctant to use conservative methods in the treatment of tibial tuberosity avulsion fractures due to the uncertain outcome and possible fracture progression. There are many surgical treatment options, but Kirschner wires with a tension band are the surgical method of choice for managing the problem. This article also contains a detailed description of the surgical procedure with the recommended method. The manuscript additionally touches on rehabilitation and conservative treatment of tibial tuberosity avulsion fractures.

Good clinical outcomes achieved in young dogs with tibial tuberosity avulsion fracture repairs when implants were left in situ past skeletal maturity.

To evaluate outcomes of tibial tuberosity avulsion fractures (TTAF) in dogs with implants left in situ past skeletal maturity and to compare clinical outcomes with published outcomes in dogs whose implants were removed 4 to 6 weeks postoperatively. 47 client-owned dogs. In this retrospective study, 47 dogs had surgery to correct a TTAF before 10 months of age and had the implants left in situ past skeletal maturity. Of these, 42 were followed for a median of 36 months postoperatively. Short- and long-term complications were recorded and compared with historically published data in which the implants were removed within 6 weeks of surgery. 14% (6/42) of our population experienced minor long-term complications (stiffness and lameness), 6% (3/47) experienced major short-term complications (repair failure), and 14% (6/24) experienced major long-term complications (implant removal). There was no difference in long-term outcomes when compared with results of historical reports in which implants were removed 4 to 6 weeks postoperatively. Client satisfaction was high, with 93% (38/41) grading outcomes as excellent and 95% (39/41) stating they would have surgery performed again in retrospect. Immature dogs with surgically repaired TTAFs have favorable long-term outcomes when the implants were left in situ past skeletal maturity. Dogs with TTAF repairs may not need implant removal unless it becomes clinically necessary. Avoiding a second procedure will decrease patient morbidity, recovery time, and cost.

Successful conservative treatment for Ogden type-IV tibial tubercle avulsion fracture with transverse fibular fracture in 15 years old boy in remote area: a case report

Background: Tibial tubercle avulsion fracture is very rare. Its incidence has been reported to account for only 3% of all proximal tibia fractures and less than 1% of all growth plate injuries. This fracture occurs when the quadriceps are forcefully contracted against resistance, such as during jumping, or when rapid knee flexion occurs with contracted quadriceps, such as during landing. Most authors recommended surgical options in type IV tibial tubercle avulsion; however, we reported successful conservative treatment in this case report. Case report: A 15-year-old male athlete with no significant past medical history presented via emergency medical services after a ground-level fall while playing basketball which landed with his left foot in a pivot position. He felt immediate pain and swelling about the left knee, all sensation was intact, as were pedal pulses, and neurovascularly remained intact. The patient did not want to go for medical evacuation to do surgery and consent to be managed with conservative treatment with close follow-up. Conclusion: The results and prognosis of these fractures are excellent, despite the fracture pattern or treatment used, as long as an anatomical reduction is obtained

Early Knee Range of Motion Following Operative Treatment for Tibial Tubercle Avulsion Fractures Is Safe.

Tibial tubercle avulsion fractures (TTAF) often require surgical reduction and stabilization. Traditional teachings recommend postoperative knee immobilization for 4 to 6 weeks; however, the necessity of these restrictions is unclear and the actual practice varies. This study's purpose was to: (1) retrospectively review operatively managed TTAFs at a single center to examine the spectrum of postoperative rehabilitation guidelines, and (2) compare the outcomes of patients based on the timing of initiation of postoperative knee range of motion (ROM). Operatively managed TTAFs treated at a single center from 2011-2020 were identified. Patients with polytrauma, associated lower extremity compartment syndrome, or treatment other than screw fixation were excluded. Patient demographics, mechanism of injury, Ogden Classification, associated injuries, operative technique, postoperative ROM progression, and time to release to unrestricted activities were collected. Patients were grouped based on the initiation of postoperative ROM as Early (<4wk, EROM) or Late (≥4wk, LROM). Bivariate analysis was used to compare characteristics between these 2 groups. Study criteria identified 134 patients, 93.3% (n=125) of whom were male. The mean age of the cohort was 14.77 years [95% confidence interval (CI: 14.5 to 15.0]. Forty-nine patients were designated EROM; 85 patients were categorized as LROM. The groups did not differ significantly with regards to age, race, injury characteristics, or surgical technique. Both groups progressed similarly with regards to postoperative range of motion. Ultimate activity clearance was achieved at ~20 weeks postoperatively without differences between groups ( P >0.05). Four instances of postoperative complication were identified, all of which occurred in the LROM group. A broad range of postoperative immobilization protocols exists following the screw fixation of TTAFs. Across otherwise similar cohorts of patients undergoing operative treatment, initiation of knee range of motion before 4 weeks was without complication and provided equivalent outcomes to traditional immobilization practices. Given the clear benefits to patients and caregivers provided by the permission of early knee motion and the avoidance of casting, providers should consider more progressive postoperative rehab protocols following operatively treated TTAFs. Level III, Retrospective Cohort.

Mechanical Testing of the New Cage for Tibial Tuberosity Advancement with the Cranial Implant Fixation (TTA CF) Technique-Ex Vivo Study on Sheep Model.

Simple SummaryTibial tuberosity advancement is a method of surgical treatment of cranial cruciate ligament rupture in animals.. In previous reports, the biomechanical effectiveness of tibial tuberosity advancement surgeries was evaluated by axial pressure on the tibial tuberosity to test the strength and resistance of the fixation or by pulling on the tuberosity. To our knowledge, there are no reports that examined the strength that is needed to pull out an implant from the tibia after tibial advancement. This study is the first report that focuses on pulling out the TTA implant, which corresponds to the biointegrity and ingrowth of the TTA cage with the tibia.Background: Modifications of tibial tuberosity advancement are well accepted for cranial cruciate rupture repair. We compared the loads that were needed to pull the TTA CF cage out in the two groups. The first group consisted of five sheep in which osteotomy and TTA CF cage fixation were performed as assumed preoperatively. The second group consisted of five sheep in which intraoperative or postoperative discrepancies from preoperative planning were found. This is also the first report describing biomechanical testing after tibial tuberosity advancement with cranial implant fixation (TTA CF) surgical procedures. Results: A total of 10 ovine proximal tibiae were tested biomechanically by tearing out TTA CF implants from the bone. The mean maximal loaded forces to pull out the cage in Group 1, in which fixation of the implant was performed as assumed preoperatively, was 878 ± 61 N, and in Group 2, in which discrepancies from preoperative planning were found, was 330 ± 55 N. The mean implant displacement under maximal load to failure was 2.6 mm and 2.2 mm in Groups 1 and 2, respectively. There was a significant difference between Group 1 and Group 2 in the maximal loads-to-failure; however, the difference in the displacement at maximal loaded forces to pull out the cage was not significant between the groups. Conclusions: The mean maximal loaded forces to pull out the cage was significantly lower in Group 2, where discrepancies from preoperative planning were found (878 ± 61 N vs. 330 ± 55 N). The lower forces that were needed to extract the TTA CF implant from the tibia can lead to the conclusion that biointegration of the implant is also weaker. Correct positioning of the osteotomy line and TTA CF implant is essential for good biointegrity and thus for limiting complications in the form of tibial tuberosity avulsion fracture or tibial shaft fracture.

Avulsion Fracture of the Tibial Tubercle in Adolescents: 3 Cases and Review of the Literature

Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle. Of all proximal tibial fractures, approximately 3% are tibial tubercle avulsion fractures. We report 3 cases of anterior tibial tubercle fractures in 3 adolescents treated at the pediatric surgical emergency department in Rabat. Standard radiographs of the knee will reveal the avulsed tibia tubercle and also allow fracture classification. There are multiple classification systems with multiple modifiers. The most commonly used is the modified Ogden classification. Tibial tubercle avulsion fractures can be associated with concomitant soft tissue damage, periosteal damage, and compartment syndrome leading to extensor mechanism disruption, joint laxity, or vascular compromise. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Satisfactory results are usually achieved.

The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty

AimsThe aim of this study was to determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA), with consideration of the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial unicondylar knee arthroplasty (UKA-M) and bicruciate-retaining total knee arthroplasty (BCR-TKA).MethodsTwo experimentally validated finite element models of tibia were implanted with UKA-M, Bi-UKA, and BCR-TKA. Intraoperative loads were applied through the condyles, anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone.ResultsPeak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2 mm had a much larger effect, resulting in a six-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, although the smaller, less dense female model had a 1.4 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA.ConclusionTibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for smaller and less dense tibiae. To minimize risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bone island anteriorly.Cite this article: Bone Joint Res 2022;11(8):575–584.

Tibial Tubercule Avulsion Fracture in Child Soccer Player: A Conservative Approach

Tibial Tubercle Avulsion Fracture (TTAF) is an uncommon disease. They are usually found during childhood-adolescent age and described as non-traumatic fractures during running with direct physis affection. In order to avoid growth complications, which would lead to harmful consequences for the patient, an accurate diagnosis following a solid treatment has to be carried out. We describe a case report of a 12-year-old football player boy with a tibial tuberosity avulsion following a conservative treatment. Pharmacological treatment and a rehabilitation program was prescribed with a satisfactory evolution. Even though one of the physician consulted suggested open reduction and internal fixation, the medical staff for his team decided a more conservative approach which came out as an adequate management for this case. After a two years follow up the evolution was successful and the player was able to perform every football specific activity pain free and without any kind of limitation.

Type VII Tibial Tubercle Fractures are Different from Osgood Schlatter Syndrome and Tibial Tubercle Physeal Fractures

Introduction:Children and adolescents are prone to both overuse and acute injuries at the tibial tubercle. The most common overuse injury is Osgood Schlatter Syndrome (OSS,) and the most common acute severe injury is tibial tubercle avulsion fracture (TTF). Here we present evidence for a Type VII, all-epiphyseal, tibial tubercle fracture (VIITF) that is different from OSS and TTF.Methods:This IRB–approved study involved patients that were treated and registered at a tertiary care pediatric hospital from 2014 to 2020. We compared the clinical information, the radiographs, the treatments, and the outcomes of 15 patients with VIITF to 19 patients with OSS and to 14 patients with TTF.Results:All VIITF patients had a sudden onset of pain associated with a specific sports-related injury, and all had lateral radiographs showing a chip-like ossific fragment displaced from the secondary center but with no involvement of the physis. All of the OSS patients had an insidious onset of symptoms with no specific injury, and none had radiographs showing a chip-like fragment. All the TTF patients had a sudden onset of pain after an acute injury. Eleven of the 15 VIITF patients (73%) have formed retro-patellar tendon ossicles, and 7 of those patients (46%) have undergone surgery. All but one of the OSS patients have resolved, and all with non-operative management. All the TTF patients have resolved, and all except those with Ogden type IA fractures, had undergone urgent surgery.Conclusions:We accepted our hypothesis. VIITF is different from OSS and TTF and can be differentiated on the basis of clinical and radiographic data.Clinical Relevance:Most patients with OSS resolve with non-operative management, and TTF patients usually require urgent surgery. Children with VIITF do not need urgent surgery but do need to be followed because some can form painful retro-patellar tendon ossicles, have focal anterior knee pain, and may need surgery to resolve their symptoms. Level of Evidence: Level III: Case Control Study.

Factors Contributing to the Need for Non-Elective Explant following Surgical Repair of Tibial Tuberosity Avulsion Fracture.

The aim of this study was to evaluate factors contributing to the need for non-elective explant following surgical repair of tibial tuberosity avulsion fractures. Retrospective multicentre case-control study. Over a 5-year period, dogs (n = 63) that underwent surgical repair of tibial tuberosity avulsion fractures (n = 64) were considered. Dogs that underwent a non-elective explant were compared with those that did not. Continuous variables were compared with the Mann-Whitney U test. Categorical variables were compared with the Fisher's exact test. Variables which were significant on univariate analysis were entered into a multiple logistic regression model. Significance was set at p < 0.05. Non-elective explant was performed in 20/64 fractures and elective explant was performed in 2/64 fractures. Neutered dogs were found to be 19 times (95% confidence interval: 2.1-172) more likely to require explant compared with intact dogs (p = 0.009). Every 0.25 mm increase in average pin size was found to make it 2.5 times (95% confidence interval: 1.3-4.9) more likely to require explant (p = 0.006). The findings suggest that use of the smallest appropriate pin should be considered for standard surgical repair of tibial tuberosity avulsion fractures to minimize the risk of requiring non-elective explant.