Avulsion Fracture of the Tibial Tuberosity in Adolescents: A Rare Case and Surgical Fixation Technique
-
Farzad Amouzadeh Omrani
,
Kourosh Kharkan Ghamsari
,
Mojtaba Baroutkoub
,
Sina Afzali
,
Saeed Kookly
Abstract
Background: Only 3% of all proximal tibial fractures result in an avulsion fracture of the tibial tuberosity. It is often seen in youngsters between the ages of 3 and 6 and is less frequent after puberty.
Case Report: A 15-year-old boy was presented with severe left knee pain following a high jump. X-ray and computed tomography (CT) scan showed a tibial tuberosity fracture with joint surface involvement. The damaged part was fixed with a 4.5mm cannulated screw and washer, reinforced with 2 SwiveLock anchors. In the sixth week, full weight bearing and full range of motion (ROM) were obtained.
Conclusion: The primary objective in managing tibial tubercle fractures is the restoration of both the extensor mechanism and the integrity of the joint surface in cases where they have been compromised.
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2. Mann DC, Rajmaira S. Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years. J Pediatr Orthop. 1990;10(6):713-6. doi: 10.1097/01241398- 199011000-00002. [PubMed: 2250054].
3. Chow SP, Lam JJ, Leong JC. Fracture of the tibial tubercle in the adolescent. J Bone Joint Surg Br. 1990;72(2):231-4. doi: 10.1302/0301-620X.72B2.2312561. [PubMed: 2312561].
4. Christie MJ, Dvonch VM. Tibial tuberosity avulsion fracture in adolescents. J Pediatr Orthop. 1981;1(4):391-4. doi: 10.1097/01241398-198112000-00006. [PubMed: 7334117].
5. Hand WL, Hand CR, Dunn AW. Avulsion fractures of the tibial tubercle. J Bone Joint Surg Am. 1971;53(8):1579-83. [PubMed: 5121798].
6. Mosier SM, Stanitski CL. Acute tibial tubercle avulsion fractures. J Pediatr Orthop. 2004;24(2):181-4. doi: 10.1097/00004694-200403000-00009. [PubMed: 15076604].
7. Pretell-Mazzini J, Kelly DM, Sawyer JR, Esteban EM, Spence DD, Warner WC, et al. Outcomes and complications of tibial
tubercle fractures in pediatric patients: A systematic review of the literature. J Pediatr Orthop. 2016;36(5):440-6. doi: 10.1097/BPO.0000000000000488. [PubMed: 25887827].
8. Ehrenborg G. The Osgood-Schlatter lesion. A clinical study of 170 cases. Acta Chir Scand. 1962;124:89-105. [PubMed: 13889499]. 9. Blanks RH, Lester DK, Shaw BA. Flexion-type Salter II fracture of
the proximal tibia. Proposed mechanism of injury and two case studies. Clin Orthop Relat Res. 1994;(301):256-9. [PubMed: 8156685].
10. Dvonch VM, Bunch WH. Pattern of closure of the proximal femoral and tibial epiphyses in man. J Pediatr Orthop. 1983;3(4):498-501. doi: 10.1097/01241398-198309000-00015. [PubMed: 6630496].
11. Ogden JA, Southwick WO. Osgood-Schlatter's disease and tibial tuberosity development. Clin Orthop Relat Res. 1976;(116): 180-9. [PubMed: 1277640].
12. Haines RW, Mohiuddin A, Okpa FI, Viega-Pires JA. The sites of early epiphysial union in the limb girdles and major long bones of man. J Anat. 1967;101(Pt 4):823-31. [PubMed: 6059827]. [PubMed Central: PMC1270916].
13. Howarth WR, Gottschalk HP, Hosalkar HS. Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease. J Child Orthop. 2011;5(6):465- 70. doi: 10.1007/s11832-011-0369-8. [PubMed: 23205148]. [PubMed Central: PMC3221755].
14. Mubarak SJ, Kim JR, Edmonds EW, Pring ME, Bastrom TP. Classification of proximal tibial fractures in children. J Child Orthop. 2009;3(3):191-7. doi: 10.1007/s11832-009-0167-8. [PubMed: 19308478]. [PubMed Central: PMC2686808].
15. Roy SP, Nag K. Simultaneous bilateral tibial tuberosity avulsion fractures in adolescence: Case report and review of 60 years of literature. Injury. 2013;44(12):1953-5. doi: 10.1016/j.injury.2013.04.006. [PubMed: 23725870].
16. Brey JM, Conoley J, Canale ST, Beaty JH, Warner WC, Kelly DM, et al. Tibial tuberosity fractures in adolescents: Is a posterior metaphyseal fracture component a predictor of complications? J Pediatr Orthop. 2012;32(6):561-6. doi: 10.1097/BPO.0b013e318263a370. [PubMed: 22892616].
17. Frey S, Hosalkar H, Cameron DB, Heath A, David HB, Ganley TJ. Tibial tuberosity fractures in adolescents. J Child Orthop. 2008;2(6):469-74. doi: 10.1007/s11832-008-0131-z. [PubMed: 19308544]. [PubMed Central: PMC2656872].
18. Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: Complications, classification, and the need for intra-articular assessment. J Pediatr Orthop. 2012;32(8): 749-59. doi: 10.1097/BPO.0b013e318271bb05. [PubMed: 23147615].
19. Crock HV. An atlas of vascular anatomy of the skeleton and spinal cord. London, UK: Martin Dunitz; 1996.
20. Pape JM, Goulet JA, Hensinger RN. Compartment syndrome complicating tibial tubercle avulsion. Clin Orthop Relat Res. 1993;(295):201-4. [PubMed: 8403649].
21. Wiss DA, Schilz JL, Zionts L. Type III fractures of the tibial tubercle in adolescents. J Orthop Trauma. 1991;5(4):475-9. doi: 10.1097/00005131-199112000-00015. [PubMed: 1762011].
22. ZaiziA,ElYT,ChafryB,BoussougaM.Tibialtubercleavulsion fractures in school sports injury: A case report. Int J Surg Case Rep. 2019;58:30-2. doi: 10.1016/j.ijscr.2019.03.017. [PubMed: 30999150]. [PubMed Central: PMC6468141].
23. Riccio AI, Tulchin-Francis K, Hogue GD, Wimberly RL, Gill CS, Collins D, et al. Functional outcomes following operative treatment of tibial tubercle fractures. J Pediatr Orthop. 2019;39(2):e108-e113. doi: 10.1097/BPO.0000000000001087. [PubMed: 29016428].
24. Shin YW, Kim DW, Park KB. Tibial tubercle avulsion fracture according to different mechanisms of injury in adolescents: Tibial tubercle avulsion fracture. Medicine (Baltimore). 2019;98(32):e16700. doi: 10.1097/MD.0000000000016700. [PubMed: 31393372]. [PubMed Central: PMC6709189].
25. Ogden JA, Tross RB, Murphy MJ. Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am. 1980;62(2): 205-15. [PubMed: 7358751].
26. Cole WW 3rd, Brown SM, Vopat B, Heard WMR, Mulcahey MK. Epidemiology, diagnosis, and management of tibial tubercle avulsion fractures in adolescents. JBJS Rev. 2020;8(4):e0186. doi: 10.2106/JBJS.RVW.19.00186. [PubMed: 32304501].
2. Mann DC, Rajmaira S. Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years. J Pediatr Orthop. 1990;10(6):713-6. doi: 10.1097/01241398- 199011000-00002. [PubMed: 2250054].
3. Chow SP, Lam JJ, Leong JC. Fracture of the tibial tubercle in the adolescent. J Bone Joint Surg Br. 1990;72(2):231-4. doi: 10.1302/0301-620X.72B2.2312561. [PubMed: 2312561].
4. Christie MJ, Dvonch VM. Tibial tuberosity avulsion fracture in adolescents. J Pediatr Orthop. 1981;1(4):391-4. doi: 10.1097/01241398-198112000-00006. [PubMed: 7334117].
5. Hand WL, Hand CR, Dunn AW. Avulsion fractures of the tibial tubercle. J Bone Joint Surg Am. 1971;53(8):1579-83. [PubMed: 5121798].
6. Mosier SM, Stanitski CL. Acute tibial tubercle avulsion fractures. J Pediatr Orthop. 2004;24(2):181-4. doi: 10.1097/00004694-200403000-00009. [PubMed: 15076604].
7. Pretell-Mazzini J, Kelly DM, Sawyer JR, Esteban EM, Spence DD, Warner WC, et al. Outcomes and complications of tibial
tubercle fractures in pediatric patients: A systematic review of the literature. J Pediatr Orthop. 2016;36(5):440-6. doi: 10.1097/BPO.0000000000000488. [PubMed: 25887827].
8. Ehrenborg G. The Osgood-Schlatter lesion. A clinical study of 170 cases. Acta Chir Scand. 1962;124:89-105. [PubMed: 13889499]. 9. Blanks RH, Lester DK, Shaw BA. Flexion-type Salter II fracture of
the proximal tibia. Proposed mechanism of injury and two case studies. Clin Orthop Relat Res. 1994;(301):256-9. [PubMed: 8156685].
10. Dvonch VM, Bunch WH. Pattern of closure of the proximal femoral and tibial epiphyses in man. J Pediatr Orthop. 1983;3(4):498-501. doi: 10.1097/01241398-198309000-00015. [PubMed: 6630496].
11. Ogden JA, Southwick WO. Osgood-Schlatter's disease and tibial tuberosity development. Clin Orthop Relat Res. 1976;(116): 180-9. [PubMed: 1277640].
12. Haines RW, Mohiuddin A, Okpa FI, Viega-Pires JA. The sites of early epiphysial union in the limb girdles and major long bones of man. J Anat. 1967;101(Pt 4):823-31. [PubMed: 6059827]. [PubMed Central: PMC1270916].
13. Howarth WR, Gottschalk HP, Hosalkar HS. Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease. J Child Orthop. 2011;5(6):465- 70. doi: 10.1007/s11832-011-0369-8. [PubMed: 23205148]. [PubMed Central: PMC3221755].
14. Mubarak SJ, Kim JR, Edmonds EW, Pring ME, Bastrom TP. Classification of proximal tibial fractures in children. J Child Orthop. 2009;3(3):191-7. doi: 10.1007/s11832-009-0167-8. [PubMed: 19308478]. [PubMed Central: PMC2686808].
15. Roy SP, Nag K. Simultaneous bilateral tibial tuberosity avulsion fractures in adolescence: Case report and review of 60 years of literature. Injury. 2013;44(12):1953-5. doi: 10.1016/j.injury.2013.04.006. [PubMed: 23725870].
16. Brey JM, Conoley J, Canale ST, Beaty JH, Warner WC, Kelly DM, et al. Tibial tuberosity fractures in adolescents: Is a posterior metaphyseal fracture component a predictor of complications? J Pediatr Orthop. 2012;32(6):561-6. doi: 10.1097/BPO.0b013e318263a370. [PubMed: 22892616].
17. Frey S, Hosalkar H, Cameron DB, Heath A, David HB, Ganley TJ. Tibial tuberosity fractures in adolescents. J Child Orthop. 2008;2(6):469-74. doi: 10.1007/s11832-008-0131-z. [PubMed: 19308544]. [PubMed Central: PMC2656872].
18. Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: Complications, classification, and the need for intra-articular assessment. J Pediatr Orthop. 2012;32(8): 749-59. doi: 10.1097/BPO.0b013e318271bb05. [PubMed: 23147615].
19. Crock HV. An atlas of vascular anatomy of the skeleton and spinal cord. London, UK: Martin Dunitz; 1996.
20. Pape JM, Goulet JA, Hensinger RN. Compartment syndrome complicating tibial tubercle avulsion. Clin Orthop Relat Res. 1993;(295):201-4. [PubMed: 8403649].
21. Wiss DA, Schilz JL, Zionts L. Type III fractures of the tibial tubercle in adolescents. J Orthop Trauma. 1991;5(4):475-9. doi: 10.1097/00005131-199112000-00015. [PubMed: 1762011].
22. ZaiziA,ElYT,ChafryB,BoussougaM.Tibialtubercleavulsion fractures in school sports injury: A case report. Int J Surg Case Rep. 2019;58:30-2. doi: 10.1016/j.ijscr.2019.03.017. [PubMed: 30999150]. [PubMed Central: PMC6468141].
23. Riccio AI, Tulchin-Francis K, Hogue GD, Wimberly RL, Gill CS, Collins D, et al. Functional outcomes following operative treatment of tibial tubercle fractures. J Pediatr Orthop. 2019;39(2):e108-e113. doi: 10.1097/BPO.0000000000001087. [PubMed: 29016428].
24. Shin YW, Kim DW, Park KB. Tibial tubercle avulsion fracture according to different mechanisms of injury in adolescents: Tibial tubercle avulsion fracture. Medicine (Baltimore). 2019;98(32):e16700. doi: 10.1097/MD.0000000000016700. [PubMed: 31393372]. [PubMed Central: PMC6709189].
25. Ogden JA, Tross RB, Murphy MJ. Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am. 1980;62(2): 205-15. [PubMed: 7358751].
26. Cole WW 3rd, Brown SM, Vopat B, Heard WMR, Mulcahey MK. Epidemiology, diagnosis, and management of tibial tubercle avulsion fractures in adolescents. JBJS Rev. 2020;8(4):e0186. doi: 10.2106/JBJS.RVW.19.00186. [PubMed: 32304501].
| Files | ||
| Issue | Vol 10 No 1 (2024) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v10i1.14970 | |
| Keywords | ||
| Knee Fractures Avulsion Fracture Knee Internal Fixation Sports | ||
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How to Cite
1.
Amouzadeh Omrani F, Kharkan Ghamsari K, Baroutkoub M, Afzali S, Kookly S. Avulsion Fracture of the Tibial Tuberosity in Adolescents: A Rare Case and Surgical Fixation Technique. J Orthop Spine Trauma. 2024;10(1):39-41.
