Stress avulsion of the tibial tuberosity after tension band wiring of a patellar fracture: a case report

Abstract

IntroductionTo the best of our knowledge there is no other report of an elderly patient who was surgically treated for a patellar fracture with tension band wiring and who subsequently suffered from an avulsion fracture of the tibial tuberosity. The combination of a patellar fracture and avulsion of the patellar ligament has only been described as complication after bone-patellar tendon-bone anterior cruciate ligament reconstructions. However, due to demographic changes and more elderly patients treated this injury may become more frequent in future.Case presentationWe present the case of an 81 year old female who sustained an oblique patellar fracture after a direct contact injury of the left knee when falling on ice. Consequently the patellar fracture was openly reduced and stabilized with tension band wiring. The follow-up was uneventful till three months after surgery when the patient noticed a spontaneous avulsion fracture of the tibial tuberosity (Ogden type 3). The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. Intraoperatively multiple bone cysts were seen. Biopsies were not taken to prevent further fragmentation of the tibial tuberosity. The patient was followed up with anteroposterior and lateral full weight bearing radiographs and clinical assessment at 6, 12 weeks and 6 months after surgery. Recovery was completely pain free with full satisfaction.ConclusionIn conclusion in elderly patients with a patella fracture a possible associated but not obvious fracture of the tibial tuberosity should be ruled out and the postoperative rehabilitation protocol after tension band wiring of the patella might have to be individually adjusted to bone quality and course of the fracture.

Extensor mechanism reconstruction and joint preservation surgery following a tibial tuberosity fracture in giant cell tumor of bone: A case report

“…An isolated tibial tuberosity fracture in an adult is very uncommon. Our literature search revealed only five reports describing this injury in normal bone, three in Paget's disease of bone and in one case involving a Giant Cell Tumor of bone [2] , [5] , [8] , [9] , [10] , [11] , [12] , [13] , [14] . Table 1 .…”

“… Study Year Comorbidity Sex Age (yrs) Mechanism of injury Fixation method Kanawati and Lorentzos [14] . 2009 Nil F 88 Low energy fall Cannulated Screw and Tension Band Wiring Hirschmann et al [12] 2009 Nil F 81 Knee gave away while descending stairs Screws and Arthrex FibreWire® Pires e Albuquerque et al [11] 2013 Nil M 62 Direct trauma Cannulated Screws 6.5 mm Parinyakhup and Boonriong [2] 2020 Nil F 64 Direct trauma Arthrex FibreWire® Brown et al [13] 2020 Nil M 86 Low energy fall Screw and Arthrex Corkscrew® Suture Anchor Coombes W [10] . 1972 PDB M 32 Low energy fall Sutures through the bone Douglas D.L.…”

Split Fracture: A Complication of Cerclage Wiring of Acute Patellar Fracture

“…Complication rate following the fixation of patellar fracture can be up to 60% ( 2 ). The complications include hardware failure, non-union, intra-articular non-union and development of post-traumatic arthritis, deep infection and sinus tract formation, arthrofibrosis and knee stiffness, quadriceps wasting, symptomatic hardware, migration of broken cerclage wire, stress avulsion of the tibial tuberosity, patella baja, patellar necrosis from blood interference, and peripheral nerve disturbance especially of the branches of the saphenous nerve ( 3 - 12 ). The risk of their occurrence may be augmented by patient-, injury-, and treatment-related factors ( 5 ).…”