Atypical Tibial Tuberosity Fracture in an Adolescent

Abstract

Avulsion fractures of the tibial tuberosity are typically sustained by adolescent males during sporting activities. Tibial tuberosity avulsions with simultaneous proximal tibial epiphyseal fractures are rare injuries. We present an unusual case of Ogden type IIIA avulsion fracture of tibial tuberosity with a Salter Harris type IV posterior fracture of proximal tibial epiphysis in a 13-year-old boy. We believe that the patient sustained the tibial tuberosity avulsion during the take-off phase of a jump while playing basketball due to sudden violent contraction of the quadriceps as the knee was extending. This was then followed by the posterior Salter Harris type IV fracture of proximal tibial physis as he landed on his leg with enormous forces passing through the knee. Although standard radiographs were helpful in diagnosing the complex fracture pattern, precise configuration was only established by computed tomography (CT) scan. The scan also excluded well-recognized concomitant injuries including ligament and meniscal injuries. Unlike other reported cases, our patient did not have compartment syndrome. Anatomic reduction and stabilization with a partially threaded transepiphyseal cannulated screw and a metaphyseal screw followed by early mobilization ensured an excellent recovery by the patient.Our case highlights the importance of vigilance and a high index of suspicion for coexisting fractures or soft tissue injuries when treating avulsion fractures of tibial tuberosity. A CT scan is justified in such patients to recognize complex fracture configurations, and surgical treatment should be directed appropriately to both the fractures followed by early rehabilitation. Patients with such injuries warrant close monitoring for compartment syndrome during the perioperative period.

Lessons learnt from managing an avulsion fracture of the tibial tubercle extending into the tibial physis

“…This allows appreciation of the fracture configuration prior to surgery and aids planning of the reduction and fixation methods. This use of CT imaging in complex fracture patterns is also recommended by other authors 26. During the second operation, arthroscopy was used to ensure accurate fracture reduction, an approach recommended previously 25.…”

Bilateral Simultaneous Tibial Tubercle Avulsion in an Adolescent Football Player with Previous Bilateral Osgood–Schlatter Disease

“…Although the role of Osgood–Schlatter disease in the genesis of this injury is controversial [15], there are cases reported previously with this affection [2, 16–19]. Osteogenesis imperfecta also has been proposed as a predisponding factor.…”

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

“…It has also been reported that obesity is associated with more frequent fracture in children [13] and weakness of physis relative to the tension applied during intense muscle loading. TTAF traumas regarding its biomechanics could lead to patellar tendon rupture, meniscal tears, cruciate ligament damage and collateral injuries [14] the type and extension of the injury will be determined by the mechanism and secondary ossification stage.…”