Management of pediatric tibial tubercle fractures: Is surgical treatment really necessary?

Betegón, P Checa; Arvinius, Camilla; González, M; García, Anel Gómez; Martín, R Del Pozo; Martínez, Fernando Marco

doi:10.1007/s00590-019-02390-x

Cited by 14 publications

(50 citation statements)

References 14 publications

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“…In our case series, similarly to other studies [6][7][8], we found a predominance of TTAFs on the left side (80% of patients), presumably because nondominant leg (the left one in a larger percentage of the population) usually thrusts jumping/landing in sports activities [2,4,7,10].…”

Section: Resultssupporting

confidence: 90%

“…It is a rare condition but, if diagnosis and treatment are delayed, its consequences can be devastating [1,7,10]. Frey et al [10] performed a fasciotomy in four of their patients (two of them as a prophylactic measure), Checa Betegón et al [6] did it in one patient, and so did we in two of ours.…”

Section: Resultsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

“…On the other hand, surgical treatment should be considered in displaced fractures, which happens in more than 80% of TTAFs, or when there is intra-articular extension of the fracture line [1,2,6,7,12,13]. This typically applies to type II-V fractures [3,6,10,15]. There are several surgical options, including ORIF with cannulated screws or K-wires, closed reduction and percutaneous pinning, arthroscopy or soft tissue repair [1][2][3]5,7,[10][11][12][13]15].…”

Section: Resultsmentioning

confidence: 99%

“…There is a low incidence of complications and functional outcomes are generally great, regardless of the type of treatment [1][2][3][4][5][6][7][10][11][12][13][14]. Over 97% of patients acquire complete knee range of motion and return to preinjury level of sports activity [1,3,4,[6][7][8][9]11,13,14].…”

Section: Introductionmentioning

confidence: 99%

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Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life

Lima

Cabral

Boavida

et al. 2021

Journal of Pediatric Orthopaedics B

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The objective of the study was to assess functional outcomes and quality of life of patients treated for tibial tubercle avulsion fractures (TTAFs). Retrospective study of patients under 18 years of age treated from June 2011 to May 2018. Demographic data included age, gender, mechanism of injury, side, fracture classification, associated injuries, predisposing factors, and type of treatment. Clinical results included knee range of motion, pain, return to sports, overall satisfaction, functional outcomes, and complications. At final follow-up, Tegner Lysholm Knee Scoring Scale, and Kidscreen-10 were applied. Ten patients were included, all males, with a median age of 15 years. Mechanism of injury: football (three patients), basketball (two patients), running (two patients), handball (one patient), gymnastics (one patient), and fall (one patient). Nine were treated surgically with reduction and fixation with cannulated screws or Kirschner wires, plus treatment of associated injuries (three patellar tendon avulsions, one contralateral proximal tibia epiphyseal fracture, and two prophylactic fasciotomies). One patient developed mild recurvatum and two presented minor decreased knee flexion. Eight patients returned to their previous level of sports activity. Median Tegner Lysholm Knee Score was 100/100 and Kidscreen-10 was 50/50. With appropriate treatment, nearly 100% of TTAFs have good functional outcomes and low impact on quality of life.

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Section: Resultssupporting

confidence: 90%

Section: Resultsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life

Lima

Cabral

Boavida

et al. 2021

Journal of Pediatric Orthopaedics B

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Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review

Kalifis

Fermín

Seil

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose There is growing interest in tibial tubercle fractures in pediatric and adolescent population within the last decade. However, there is limited evidence in the existing literature. Therefore, the purpose of this systematic review was to analyze and provide up-to-date data that may prove valuable in decision making and management of these injuries in the general as well as the athletic population. Methods A systematic review of the literature in PubMed, Cochrane library and Virtual Health Library was conducted using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles published in English or Spanish, during the past 20 years, reporting outcomes of tibial tubercle fracture management in patients younger than 18 years old, with a mean follow-up of at least 6 months reporting outcomes, type of management and classiication were included. Results A total of 919 patients with 956 fractures in 25 retrospective cohort studies were included. The mean age was 14.4 ± 0.6 years while 766 [83%] were males and 740 [81%] of the injuries were sports-related. Associated injuries were reported in 91[10%] cases, most common being patellar tendon avulsion. Surgical management was chosen for 845[88%] of the cases, the vast majority being open reduction internal ixation (ORIF) with screws. Union was achieved in 954 [99.8%] cases. Complications and re-operations rate stood at 172[18%] and 161 [19% of the operations], respectively. Return to play (RTP) was reported in 11 [44%] of the studies standing at an average of 98.9% ± 3.6. Conclusion Essentially, this is an adolescent sports knee injury that needs careful planning before decision making because it may afect both RTP and joint preservation. Although union was achieved in almost all patients, there is a high risk of associated injuries, complications and reoperations. The surgeon should be conident to perform fracture ixation as well as addressing associated knee soft tissue injuries to achieve optimal outcomes. Level of evidence Level IV.

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Adolescent Tibial Tubercle Fracture: Review of Outcomes and Complications

Reyes

Pandya

2023

Curr Rev Musculoskelet Med

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Purpose of Review Fractures of the tibial tubercle are a relatively uncommon injury, representing 3% of all proximal tibia fractures and < 1% of all physeal fractures, primarily seen in the adolescent demographic. While recognition of the injury and its management is being more widely reported in the literature and recognized in the hospital setting, reports of its outcomes and complications have still been limited. This article provides an updated review of the outcomes and complications of tibial tubercle fractures. Recent Findings Current research shows both radiographic outcomes, specifically osseous union, and functional outcomes, such as return to play and full knee range of motion, are excellent in patients treated either operatively or nonoperatively. Complication rates overall remain relatively low, with the most common complication being bursitis and hardware prominence and the most common associated injuries being patellar tendon avulsions and meniscus tears. Summary With appropriate management, tibial tubercle fractures have an excellent overall outcome and a low complication rate. Although complications are uncommon, treating providers should be vigilant and recognize the signs of devastating complications resulting from acute vascular injuries or compartment syndrome. Further research should aim to analyze patients’ experiences and satisfaction following treatment of this injury and examine the long-term functional and patient-reported outcomes.

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Management of pediatric tibial tubercle fractures: Is surgical treatment really necessary?

Cited by 14 publications

References 14 publications

Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life

Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life

Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review

Adolescent Tibial Tubercle Fracture: Review of Outcomes and Complications

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