Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update

Formiconi, Federica; D’Amato, Raffaele Dario; Voto, Andrea; Panuccio, Elena; Memeo, Antonio

doi:10.1007/s00590-020-02629-y

Cited by 12 publications

(24 citation statements)

References 25 publications

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“…Previous literature has reported that 98% of patients were able to return to preinjury activity at an average of 4 months. 4 16 21 The current series demonstrates similar findings. All patients were able to return to preinjury activity at an average of 4.6 months, regardless of fracture types ( p = 0.89) or BMI ( p = 0.75).…”

Section: Discussionsupporting

confidence: 79%

Outcomes of Displaced Tibial Tubercle Fractures in Adolescents

et al. 2022

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Tibial tubercle fractures are uncommon injuries. The purpose of this study is to report the outcomes of surgical treatment of displaced tibial tubercle fractures in adolescents. This study was approved by the College of Medicine Institutional Review Board. A retrospective review was performed at our institution for patients who underwent surgical treatment of tibial tubercle fractures. Patient demographics, injury characteristics, and outcomes were recorded. A p-value of <0.05 was considered statistically significant. Nineteen male patients were identified. The average age was 14.6 years, and the average body mass index was 25.8. Basketball (63%) was the most common mechanism of injury. No patient was treated with bicortical screws. Two patients had preoperative computed tomography. One patient presented with acute compartment syndrome (ACS), and fasciotomy was performed. Twelve patients (63%) without clinical signs of ACS received anterior compartment fasciotomy on a case-by-case basis according to surgeon's preference. No growth injury, including growth arrest, angulation, or shortening occurred. All patients returned to preinjury activities at an average of 18.5 weeks. Displaced tibial tubercle fractures in this series occurred in male adolescents during athletic activity. Unicortical screws/pins were used with no loss of fixation. Routine use of advanced imaging was unnecessary. One patient (5%) underwent fasciotomy. No growth arrest occurred. All patients returned to preinjury athletic activities.

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Section: Discussionsupporting

confidence: 79%

Outcomes of Displaced Tibial Tubercle Fractures in Adolescents

et al. 2022

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“…5 Our BL group consisted of all males in this age group which is similar in previous case reports. 2,3,6,12,13 An increase in the incidence of tibial tubercle fractures has been observed, probably due to greater involvement in sports activities 6,7 ; injuries in both our groups were primarily sports related. Basketball was the most common sport implicated in the bilateral fracture cohort, which is consistent with literature.…”

Section: Discussionmentioning

confidence: 63%

“…4 In recent years, an increase in their incidence has been observed, likely due to greater involvement in sports activities. 6,7 First described in 1955, 3,8 bilateral tibial tuberosity avulsion fractures are exceedingly rare, with less than 40 total cases described primarily as single patient case reports in literature in the past 65 years. 1,3,9,10 Due to limited literature on tibial tuberosity fractures, it has been difficult to determine associated injuries, morbidity, appropriate treatment, complications, and outcomes of these fractures.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,9,10 Due to limited literature on tibial tuberosity fractures, it has been difficult to determine associated injuries, morbidity, appropriate treatment, complications, and outcomes of these fractures. 6,7 Our study reviews the largest case series of bilateral tibial tuberosity avulsion fractures reported to date, comparing this fracture to a unilateral fracture group. We also wanted to compare our case series with all the cases reported in the last 65 years with a literature search.…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous bilateral versus unilateral tibial tubercle fractures

Kushare

Wunderlich

Dranginis

2021

Journal of Clinical Orthopaedics and Trauma

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Tibial tubercle/tuberosity fractures are rare injuries in young patients accounting for less than one percent of physeal fractures. Bilateral simultaneous fractures are even rarer, with only a few case reports in literature. The purpose of our study was to describe the largest case series of bilateral simultaneous tibial tuberosity avulsion fractures and compare it with unilateral fractures. We also wanted to compare our bilateral fractures case series with all the cases reported in the last 65 years. Methods: IRB approved retrospective study involving patients under age 18 years with tibial tuberosity avulsion fractures. Bilateral simultaneous fractures were compared to a unilateral group including demographic data, mechanism of injury, clinical exam findings, complication rates, and outcomes including return to function. Statistical analysis was performed using Mann-Whitney and Fisher Exact tests to compare the different groups.Results: 138 patients (131 males, 7 females) from a tertiary children's hospital between 2012 and 2019 with tibial tuberosity avulsion fractures were included. 11 bilateral simultaneous fractures (BL Group) were identified and compared to age matched cohort from the 127 unilateral fracture patients (UL group). There was no significant difference found in BMI, height, weight, age, sex, mechanism of injury, return to functional range of motion, and return to sports between the groups. 7/11 (63%) of the patients in the BL group who sustained simultaneous fractures had to be home bound and could not attend school for an average of 8.3 weeks. There was a higher rate of complications in the BL group (63.3%) compared to the UL group (21.1%), which was statistically significant. The most common complications in the bilateral group were hardware removal and wound dehiscence. Conclusion: This first case series comparing unilateral versus bilateral simultaneous tibial tuberosity avulsion fractures suggests that the final outcomes of the two groups are similar, however it shows a significantly higher complication rate and hardware removal rate in the BL group. This study is also the first to highlight the significant initial morbidity in the BL fracture group with issues with regards to early mobility and loss of school-days. Keeping in mind the profound initial impact the bilateral injury poses to the patient; surgeons can possibly plan for rigid fixation for early mobilization to better prepare bilateral fracture patients for the early post-operative recovery process.

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“…The most commonly reported surgical method for TTF was fixation using screws with tension band wiring (TBW) if necessary. 1 , 5 , 7 Although this widely used surgery has shown good outcomes, it may be difficult to apply if the tibial tuberosity fragments are too small or severely comminuted. Therefore, we suggest a novel technique, a fixation method using 2 knotless suture anchors, as a treatment for TTF.…”

Section: Introductionmentioning

confidence: 99%

A novel technique of tibial tuberosity fracture fixation with two knotless suture anchors in an adult: A case report and literature review

Choi

Park

2022

AOTT

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Tibial tuberosity fractures are uncommon in adults. Surgery for these types of fractures is performed similarly to that of tibial tuberosity avulsion fractures in adolescents. The most commonly introduced method is to fix the displaced bone fragments using screws or wires and, if necessary, use tension band wiring for augmentation. However, if the bone fragments are too small or severely comminuted, it may be challenging to fix them using the conventional method. In this study, we introduced a fixation method using two knotless suture anchors that could be attempted in such cases. Since this surgical method fixes the bone fragments without direct damage to the bone fragments, it can be used even when the fragments are small or comminuted. This technique achieved a nearly full active range of knee motion without an extension lag at four weeks postoperatively. In addition, there were no complications related to surgery, and a complete bone union was achieved without additional dislocation. Therefore, this surgical method may be a good alternative if a fixation of the fracture is considered problematic by the conventional method.

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Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update

Cited by 12 publications

References 25 publications

Outcomes of Displaced Tibial Tubercle Fractures in Adolescents

Outcomes of Displaced Tibial Tubercle Fractures in Adolescents

Simultaneous bilateral versus unilateral tibial tubercle fractures

A novel technique of tibial tuberosity fracture fixation with two knotless suture anchors in an adult: A case report and literature review

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