Fixation is achieved under anesthesia by cutting the skin, exposing the fracture site & fixing the displaced piece of bone in position using pins & tension wire. The incision extended from Gerdy Tubercle to the tibial tuberosity. HHS Vulnerability Disclosure, Help Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. A 45-year-old man was hit on the left proximal tibia in a traffic accident. J. Schiller, S. DeFroda, and T. Blood, Lower extremity avulsion fractures in the pediatric and adolescent athlete, The Journal of the American Academy of Orthopaedic Surgeons, vol. Anterior-posterior (a) and lateral (b) X-rays 2.5 weeks following operative management demonstrates well-positioned screws with callus formation beginning at the site of injury. An 8-centimeter anterior incision was made at the superior aspect of the tibial tubercle and extended distally. Radiographic imaging revealed well-positioned screws, no evidence of new fractures or foreign bodies, and early evidence of callus formation. Biomechanically, the degree of flexion of the knee at the time of injury was considered closely related to the fracture pattern and the size of the avulsed fragments. They typically occur in adolescent males by 2005. Avulsion occurs with the violent active extension of the knee or passive flexion against contracted quadriceps muscles. Although an acute injury, tibial tuberosity avulsion is most frequently seen in young adolescents with ongoing Osgood-Schlatter disease. Unicortical Fixation is Sufficient for Surgical Treatment of Tibial Tubercle Avulsion Fractures in Children. The main factors of bone healing were as follows, first, the blood supply of proximal of tibia was better than the distal. WebAbstract. For an avulsion fracture in your pelvis or anywhere else where your healthcare provider cant apply a cast, a short period 469474, 2008. Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring. WebThe purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures. Ten patients had excellent results and 2 had fair results. The authors have no funding and conflicts of interest to disclose. Also read: Tibial plateau This wound was dressed and closed on the 14th postoperative day from fixation and by 6 weeks had finally healed. Seven patients (low-stress group) had a spontaneous ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. Tibial tubercle avulsion fractures in school sports injury: A case report. Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. 118121, 2010. Postoperative anteroposterior and lateral film radiographs in 12 months showed that fractures eventually healed. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. The .gov means its official. Georgiou G, Dimitrakopoulou A, Siapkara A, Kazakos K, Provelengios S, Dounis E. Knee Surg Sports Traumatol Arthrosc. There was sufficient concern for impending compartment syndrome which led to fascial compartment release. We use cookies on this site to enhance your user experience. While this technique provides additional fixation on the proximal aspect of the fracture and assists with meniscal repair, it carries the risk of growth plate disruption or articular surface penetration. Radiographs at 3 months showed resorption of both fracture fragments of the proximal tibial fracture and this fractures eventually healed by 12 months (Figures 3, 4). The https:// ensures that you are connecting to the Before 6, pp. Tibial tuberosity avulsion fractures are uncommon. Case Rep Orthop. This site needs JavaScript to work properly. 36, no. 2, no. This site needs JavaScript to work properly. Due to the severity of compartment syndrome and the variability in its temporal presentation from the initial injury, it is paramount that careful evaluation of vascular integrity and a low threshold for fasciotomy be in place to prevent vascular compromise. Eight cases of tibial tubercle avulsion fracture have been treated during the last 5 years. Postinjury follow-up ranged from 18 months to 5 1/2 years. All patients were functioning well at the time of reexamination. Five of eight injuries were treated with open reduction and internal fixation. To restore the native footprint of the patellar tendon, a 4.5mm PEEK (polyetheretherketone) corkscrew anchor (Arthrex, Naples, FL) was placed slightly lateral to the anatomic insertion site to avoid a stress riser on the anterior tibial cortex. 11. Tibial tubercle avulsion fractures can cause disruption to the growth plate which can cause skeletal deformities such as genu recurvatum or limb-length discrepancy, which can present in 4% and 5% of cases, respectively [8]. In this report, we present a 14-year-old male who experienced sharp pain in his knee while jumping and colliding with another player during a basketball game. describe a technique of patellar tendon reconstruction in an adolescent patient with a tibial tubercle fracture in which bioabsorbable suture anchors were placed above the growth plate on either side of the fracture site [12]. Bolesta MJ, Fitch RD. Flexion-type fractures of the proximal tibial physis: a report of five cases and review of the literature. These steps were repeated for the midpoint and distal incision sites. The primary goal in treating this injury is to restore the extensor mechanism and, if the joint space is involved (as seen in types III and IV), to restore the integrity of the joint surface [10]. 2004 Jul;12(4):271-6. doi: 10.1007/s00167-003-0417-0. Osgood-Schlatter Disease as a Possible Cause of Tibial Tuberosity Avulsion. The .gov means its official. 28, no. Preoperative anteroposterior and lateral film radiographs of the left knee showing tibial tuberosity avulsion fracture and proximal tibial fracture. This scenario raised concern for impending compartment syndrome, and an anterolateral compartment release was planned. The avulsion fracture of the tibial tuberosity is regarded as a substantial injury to the extensor mechanism as the patellar tendon is attached to the tibial tuberosity. 2022 Mar 10;92(S3):e2021571. He was discharged home later that day. Nonsurgical treatments may cause fracture malunion, anterior knee pain, and even patellar dislocation. 19, no. and transmitted securely. and transmitted securely. N. K. Pandya, E. W. Edmonds, J. H. Roocroft, and S. J. Mubarak, Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment, Journal of Pediatric Orthopedics, vol. PMC Repeat anterior-posterior and lateral X-rays demonstrated a well-reduced tibial tubercle fracture as well as well-positioned and nondisplaced hardware (Figure 6). 8. doi: 10.23750/abm.v92iS3.12580. 465470, 2011. 8600 Rockville Pike Data is temporarily unavailable. A physical exam was performed but was limited due to pain. The https:// ensures that you are connecting to the The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. Postoperative anteroposterior and lateral film radiographs in 2 days after operation. Please enable scripts and reload this page. eCollection 2020. Disclaimer, National Library of Medicine K AJ, L P. Avulsion fracture of the tibial tubercle in an adult treated with tension-band wiring: a case report. WebThree patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. They all engaged in sports or active play during the injury. We report the case of a 14-year-old healthy adolescent male basketball player who sustained this injury as a result of a collision with another player. 2003 Jul;34(3):397-403. doi: 10.1016/s0030-5898(02)00061-5. Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. Three 3-centimeter incisions were made along the anterolateral aspect of the leg. Tibial tubercle avulsion fractures are managed operatively in most cases, and long-term outcomes are favorable with the resumption of sport to the previous level [4]. WebRecovery time for a tibia fracture typically takes 4-6 months to heal completely. Georgiou G, Dimitrakopoulou A, Siapkara A, et al. The authors declare that they have no conflicts of interest. Longitudinal petrous temporal bone fracture, Transverse petrous temporal bone fracture, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Transverse vs longitudinal petrous temporal bone fracture, Transverse versus longitudinal petrous temporal bone fracture, Longitudinal versus transverse petrous temporal bone fracture, more common pattern of temporal bone fracture (70-90%), the fracture line is parallel to the long axis of the petrous temporal bone, less common pattern of temporal bone fracture (10-30%), the fracture line is perpendicular to the long axis of the petrous temporal bone, the otic capsule is often involved, resulting in, the ossicles and the tympanic membrane are usually spared, facial nerve involvement more common (~50%), fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. These injuries cause significant disruption to school and sport, but fortunately, complications are rare and functional recovery is usually complete. For more information, please refer to our Privacy Policy. 3. You might be sprinting, hitting, sliding or doing other sports activities that involve quick movements and sudden changes in direction. A piece of bone attached to a ligament or tendon breaks away from the main part of the bone. It might take up to 12 weeks for you to fully heal. An avulsion fracture in a finger. What is an avulsion fracture? 2005. M. A. Rev Chir Orthop Reparatrice Appar Mot. This report of a 45-year old male with a high energy open proximal tibial fracture associated with a displaced tibial tuberosity fracture that has been successfully managed with a planned open reduction and screw fixation of the tuberosity and a minimally invasive technique for the tibial diaphysial fracture. 251259, 2017. A debridement of the open fracture was performed and the laceration was closed. The injuries were managed with an open reduction internal fixation (ORIF) of the tibial tubercle and distal patellar tendon repair. 2, pp. Then CT scan is needed to evaluate the fracture extension to the articular joint. Postoperative anteroposterior and lateral film radiographs in 3 months after operation showed absorption of tibial fracture fragments for the cut of the patients at the time of injured breakdown. Epub 2005 Oct 24. Therefore, this technique may need to be performed under fluoroscopic guidance in order to minimize these risks. Correspondence: Yu-Ping Liu, Department of Trauma Orthopedics, Tengzhou Central People's Hospital, Shandong 277500, P.R. Purpose: 2019 Jan;122(1):6-16. doi: 10.1007/s00113-018-0590-8. He demonstrated 5/5 quadriceps strength with no evidence of an extensor lag. 9. 2020 May 5;5(5):260-267. doi: 10.1302/2058-5241.5.190026. 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. International Journal of Surgery Case Reports, https://doi.org/10.1016/j.ijscr.2019.03.017. The presence of a palpable defect between the inferior pole of the patella and tibial tuberosity should heighten clinical suspicion for associated patellar tendon rupture [7]. 4, pp. Correspondence should be addressed to: Andre Jakoi, MD, Department of Orthopaedic Surgery, Drexel College of Medicine, 245 N 15th St, Mail Stop 420, Philadelphia, PA 19102 (, Avulsion fractures of the tibial tubercle, Fractures of the tibial tuberosity in adolescents, Fracture of the tibial tubercle in the adolescent, Tibial tuberosity fractures in adolescents, Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method, Acute tibial tubercle avulsion fractures in the sporting adolescent, The SF-36 Health Survey: development and use in mental health research and the IQOLA Project, Rating systems in the evaluation of knee ligament injuries, Reliability, validity and responsiveness of the Lysholm knee scale and various chondral disorders of the knee, An unusual avulsion fracture of the proximal tibial epiphysis. Your doctor will often prescribe medications for pain-relief for a short period of time after the injury or surgery. WebA tibial tubercle avulsion fracture is a complete or incom-plete break (fracture) of the growth plate of the leg just below the knee at the tibial tubercle, a prominence just below the kneecap. In this instance, the patient did not suffer postoperative complications. After surgery exercise should be restricted for 6 weeks. Mounasamy V, Brown TE. The patient was placed in a hinged knee brace which was locked in extension. You may be trying to access this site from a secured browser on the server. Most injuries in adolescent occur during school sports like volleyball, football or basketball. 2004 Mar-Apr;24(2):181-4. doi: 10.1097/00004694-200403000-00009. http://creativecommons.org/licenses/by-nc-nd/4.0. On physical examination, he was nontender to palpation along the joint line. On the 4th day following fixation the open fracture wound broke down, but the bacteria culture was negative. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. Orthop Clin North Am. Consequently an anatomical reduction and stable fixation is required to assure it heals anatomically. Tibial tubercle fractures frequently require ORIF; Three dimensional imaging may help guide treatment but is not always necessary; Compartment syndrome following tibial tubercle WebAndrew Parker, MD 1120 Raintree Circle, Suite 280 Allen, TX 75013 Phone: (214) 383 9356 Fax: (214) 383 9886 ORIF TIBIAL TUBERCLE PROTOCOL 2020 Mar 16;2020:8650927. doi: 10.1155/2020/8650927. Please try after some time. Some error has occurred while processing your request. Nimityongskul P, Montague WL, Anderson LD. Unable to load your collection due to an error, Unable to load your delegates due to an error. Old, M. Javandel, J. Tom, and J. Realyvasquez, Tibial tubercle avulsion fractures in adolescent basketball players, Orthopedics, vol. Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. Fractures usually take about three to 12 weeks to heal completely. Bookshelf This case report is limited in the duration of follow-up. Vyas S, Ebramzadeh E, Behrend C, Silva M, Zionts LE. Intraoperatively multiple bone cysts were Bauer J, Orendi I, Ladenhauf HN, Neubauer T. Unfallchirurg. What causes this injury? A medium Hemovac drain was placed along the length of the lateral compartment, exiting in the posterolateral proximal leg. Introduction: 692696, 2012. (The Ethics Committee of Tengzhou Central People's Hospital approved the study. In cases of tibial tubercle avulsion fracture, clinicians should have a high index of suspicion to evaluate for additional injuries that may be present. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. Depending on your injury, it may take eight weeks or more for the fracture to heal. Tibial tubercle avulsions. The tibial tubercle represents the most inferior aspect of the extensor mechanism, and adolescents are at increased risk of injury due to the relative weakness of the physis compared to the tendon insertion [7]. We believed that the tibial tuberosity avulsion fracture should be considered an intraarticular fracture, because a malunion will affect the trajectory of the patella resulting in patellar subluxation and poor extension power. The remaining 9 fractures were treated with open reduction and internal fixation. Tension band suture in isolated tibial tubercle avulsion: A case report and review literatures. The anterior tibial plateau fragment was anatomically reduced using two fully threaded noncannulated screws (Arthrex, Naples, FL), while the tibial tubercle fragment was reduced via bicortical fixation with a 50mm fully threaded 3.5mm cortical screw (Arthrex, Naples, FL). Tibial Tubercle Avulsion Fracture. Rodriguez I, Seplveda M, Birrer E, Tuca MJ. This injury is most commonly seen in adolescent males during athletic activity but may also be associated in patients with osteogenesis imperfecta and Osgood-Schlatter disease [3, 4]. 27, no. 6, pp. 2006 Jan;37(1):57-60. doi: 10.1016/j.injury.2005.05.021. 8, pp. After discussing the findings with the family, the patient was scheduled to undergo open reduction internal fixation of a type IIIB fracture and repair of the patellar tendon three days following the initial injury. eCollection 2020 May. Tibial tubercle avulsion fracture (TTAF) is a rare condition frequently occur in adolescent male, this stage of development corresponds to the pre-ossification period, trauma Check for errors and try again. Additionally, upon presentation to the ER and initial clinic visit, the patient had a stable neurovascular examination, which alleviated concern regarding compartment syndrome. WebA 1-month cast immobilisation on an extended knee gives good results in the management of nondisplaced fractures. Wolters Kluwer Health Risk factors, mechanism of injury, and treatment. X-ray is the key to diagnosis. China (YDH). Petrous temporal bone fractures are classically divided into longitudinal, transverse or mixed fracture patterns, depending on the direction of fracture plane with respect to the long axis of the petrous temporal bone. A. Yousef, Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature, European Journal of Orthopaedic Surgery and Traumatology, vol. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The tendon remained attached to the inferior pole of the patella. EFORT Open Rev. Tibial tubercle avulsion fractures most commonly occur in adolescent boys and usually result from pushing off or landing while jumping. By continuing you agree to the use of cookies. He reported that he had no pain (0/10) and had 5% of his normal function at this time. Arkader A, Schur M, Refakis C, Capraro A, Woon R, Choi P. J Pediatr Orthop. Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing No complications were noted. A torn patellar tendon was noted in one adolescent having a stage IIIB avulsion fracture. Rev Chir Orthop Reparatrice Appar Mot. The anatomic repair of the patellar tendon was completed with two mattress sutures and tied. He was unable to stand and was sent to the emergency department after the wound was dressed. Case report and proposed addition to the WatsonJones classification, European Journal of Orthopaedic Surgery & Traumatology, The American Journal of Emergency Medicine, Revista Brasileira de Ortopedia (English Edition), Tibial Tubercle Avulsion Fractures in Adolescent Basketball Players, https://doi.org/10.3928/01477447-20120725-07, Adolescent tibial tubercle fractures in the time of the COVID 19: A single orthopedic trauma center experience, Fracture of tibial tuberosity in an adult with Paget's disease of the bone An interesting case and review of literature, Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern, Management of Knee Injuries in Adolescent Basketball Players, Fracture of the anterior tibial tuberosity in children, Tibial tubercle avulsion fractures in children, Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update, Functional Outcomes Following Operative Treatment of Tibial Tubercle Fractures, Tibial tubercle avulsion fracture according to different mechanisms of injury in adolescents, Bilateral tibial tubercle avulsion fractures: A pediatric orthopedic injury at high risk for compartment syndrome, Tibial Tubercle Avulsion Fracture with Multiple Concomitant Injuries in an Adolescent Male Athlete, Le fratture articolari ed extra-articolari del ginocchio, Articular and extra-articular knee fractures, Avulsion Fracture of the Tibial Tuberosity Combined with Lateral Tibial Plateau in an Adolescent, Fraturaavulso tuberosidade anterior da tbia em adolescente Relato de dois casos, Anterior avulsion fracture of the tibial tuberosity in adolescents Two case reports, Avulsionsverletzungen der proximalen Tibia, Outcomes and Complications of Tibial Tubercle Fractures in Pediatric Patients: A Systematic Review of the Literature, Tibial Tuberosity Fracture Combined With Entrapped Meniscus. Epub 2020 May 8. Would you like email updates of new search results? Transverse petrous temporal bone fracture. Tibial tubercle avulsion fractures (TTAF) are an unusual condition, resulting from a forced extension of the knee opposed to fixed leg. Compartment syndrome is associated with fractures that extend proximally (Type II), fractures that encompass the entire proximal tibial physis (type IV), and displaced fractures [6, 11, 13]. No risk factors were identified. We use cookies to help provide and enhance our service and tailor content and ads. 5, no. The first was located 3 centimeters distal to the neck of the fibula, the second was located 10 centimeters above the distal fibula tip, and the third was located at the midpoint between the two. While there lacks evidence to support an association between compartment syndrome and the type of tibial tubercle avulsion fracture and due to the variability in the temporal presentation of compartment syndrome, it is paramount that careful evaluation of vascular integrity and a low threshold for fasciotomy be in place to prevent vascular compromise. Upon intraoperative examination of the injury site, it was noted that vascular damage was present which would have led to postoperative compartment syndrome if not addressed. Type II lesions Strong contraction of the quadriceps femoris muscle during leg extension causes failure of the physis at the patellar tendon insertion [5]. It is imperative to continue to follow up these patients until they have reached skeletal maturity to ensure normal growth without any resultant osseous deformities as additional procedures, such as growth plate modulation, may be required. From the Department of Trauma Orthopedics, Tengzhou Central People's Hospital, Shandong (YPL, QHH, FL, MMW); and Department of Orthopedics, Huaian First People's Hospital, Jiangsu, P.R. Krieg JC. to maintaining your privacy and will not share your personal information without Copyright 2022 Elsevier B.V. or its licensors or contributors. Liu, Yu-Ping MD; Hao, Qing-Hai MD; Lin, Feng MD; Wang, Ming-Ming MD; Hao, Yue-Dong MD. Partial sleeve fractures of the tibia in children: an unusual fracture pattern. 2005 Dec;91(8):758-67. doi: 10.1016/s0035-1040(05)84487-3. 1, pp. Avulsion fracture of the tibial tuberosity with articular extension in an adult: a novel method of fixation. Tibial tubercle avulsion fractures occur in 0.42.7% of epiphyseal injuries and less than 1% of physeal injuries [1, 2]. Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing failure of the physis at the patellar tendon insertion. Informed written consent was obtained from the patient). government site. J Pediatr Orthop. Acute tibial tubercle avulsion fractures. 1, pp. This injury typically occurs in adolescents because the tibial tubercle is still growing and the bone is softer there. 2007. HHS Vulnerability Disclosure, Help Bookshelf Intraoperative arthroscopic view of Metzenbaum scissors releasing fascial tissue (a) and the site of injury following fascial tissue release (b). In 4 cases, the fracture was displaced and necessitated an internal fixation with plaster for about 6 weeks. Following the review of radiographic imaging, an MRI was performed, which demonstrated a type IIIB tibial tubercle avulsion fracture and complete tear of the patellar tendon from its distal attachment site, as well as a hematoma at the fracture site (Figure 2). 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). 2007 Feb;15(2):147-9. doi: 10.1007/s00167-006-0164-0. 2020 Sep 16;3(3):e000169. FOIA Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. Nikiforidis PA, Babis GC, Triantafillopoulos IK, Themistocleous GS, Nikolopoulos K. Knee Surg Sports Traumatol Arthrosc. If your ankle or hip is fractured, you may need to use crutches An avulsion fracture to your foot or ankle may require a cast or walking boot. Bethesda, MD 20894, Web Policies J Pediatr Orthop. A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. TTAF remains rare accounting for <3% of all epiphyseal injuries, it is frequent in teenage boys with open physis during school sport. J. Pretell-Mazzini, D. M. Kelly, J. R. Sawyer et al., Outcomes and complications of tibial tubercle fractures in pediatric patients: a systematic review of the literature, Journal of Pediatric Orthopedics, vol. Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes. However, Howarth et al. Open reductions and stable screw fixations precede a 3-week immobilisation for displaced fractures. In this case, suture anchors were placed along the anatomic insertion of the patellar tendon on the anterior tibial cortex. If the fracture is open or comminuted, healing time may take longer. Long-term outcome was excellent in all patients regardless of fracture type. The patient was allowed full weight bearing at 6 months, and at 12 months after operation he was asymptomatic with a full range of motion and good strength and has returned to work with no limitations (Figure 5). According to Ogden's classification, the tibial tubercle avulsion fracture was not displaced in 3 cases (stage IA) and was treated conservatively by immobilization for 6 weeks. Reference article, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-57064. Longitudinal vs transverse petrous temporal bone fracture. This case report reviews the rehabilitation program, and A. The authors report 7 cases of acute tibial tubercle avulsion fractures. Distally, the course of the superficial perineal nerve was identified and the nerve itself was protected during the distal release of the anterior compartment. In this case report, we discuss a patient who suffered a tibial tubercle avulsion fracture with multiple serious concomitant injuries, a presentation which, to our knowledge, has not previously been reported in the literature. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, September 2015 - Volume 94 - Issue 39 - p e1684-0, Tibial Tuberosity Avulsion Fracture and Open Proximal Tibial Fracture in an Adult: A Case Report and Literature Review, Articles in Google Scholar by Yu-Ping Liu, MD, Other articles in this journal by Yu-Ping Liu, MD. B. Slakey, Combined tibial tubercle avulsion fracture and patellar avulsion fracture: an unusual variant in an adolescent patient, American Journal of Orthopedics, vol. Bauer T, Milet A, Odent T, Padovani JP, Glorion C. Rev Chir Orthop Reparatrice Appar Mot. The fascial incision was extended posteriorly into the peroneal compartment and then was extended proximally and distally to the midtibia. Please enable it to take advantage of the complete set of features! official website and that any information you provide is encrypted MeSH Because of the associated soft tissue injury with these proximal tibial fractures, a displaced tuberosity fracture creates a problem in fracture management.46 Both fractures require operative management but the avulsion fracture will need an anatomical reduction to assure proper knee function.7,8 The operative management of the high energy proximal tibia fracture has been associated with a high complication rate especially with the soft tissue healing and infection.911 As a result this fracture maybe best treated with a minimally invasive technique. Preoperative sagittal view of MRI demonstrating tibial tubercle avulsion fracture (red asterisk), distal patellar tendon rupture (blue asterisk), and hematoma formation (yellow asterisk) at the site of injury. Method: According to Ogden's classification, the tibial tubercle avulsion fracture was not displaced in 3 cases (stage IA) and was treated conservatively by immobilization for 6 weeks. However, close observation in the first 2 weeks is necessary. MeSH Careers. Fracture of the anterior tibial tuberosity in children. An unusual avulsion fracture of the proximal tibial epiphysis. doi: 10.23750/abm.v92iS3.12580. Pedrazzini A, Maserati I, Cesaro G, Visigalli A, Casalini D, Bertoni N, Yewo SH, Pogliacomi F. Acta Biomed. If your pet is 4 months or under at the time of surgery, a radiograph should be taken around 3-4 weeks after surgery to evaluate the growth plate and remove the tension band wire if one was We used a minimally invasive lateral surgical approach to the tibia and extended to the tibial tubercle to achieve these goals. He was also encouraged to become full weight-bearing with the brace until its removal two months postoperatively. For a complete overview of all the cookies used, please see our privacy policy. Vella D, Peretti G, Fra F. One case of fracture of the tibial tuberosity in the adult. Drs Jakoi, Freidl, Old, Javandel, Tom, and Realyvasquez are from the Department of Orthopaedic Surgery, Drexel College of Medicine, and Dr Realyvasquez is also from the Department of Orthopaedic Surgery, St Christophers Hospital for Children, Philadelphia, Pennsylvania. Many cases are misdiagnosed and progress to recurvatum deformity especially in open physis individuals after neglected tibial tuberosity fractures. Fastest Recovery Time in Pediatric Tibial Tubercle Avulsion Fracture Repair Using SpeedBridge Double-Row Technique: A Case Report December 2020 DOI: 10.36959/453/551 M. T. Stepanovich and J. Copyright 2018 Avinesh Agarwalla et al. Published by Wolters Kluwer Health, Inc. Results with return to play at the preinjury level are favorable after treatment of acute tibial avulsion fractures in adolescent basketball players. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. J Pediatr Orthop B. The tibial tubercle ossifies in a systematic mechanism from the superior aspect of the epiphysis to the inferior margin [3]. Eight patients injured the right side, 3 the left side, and one both sides. Avulsion fractures of the tibial tubercle are uncommon school sports injuries. 2020 Sep 16;3(3):e000169. 2005 Dec;91(8):758-67. doi: 10.1016/s0035-1040(05)84487-3. Kim JW, Oh CW, Jung WJ, et al. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. A. Khoriati, S. Guo, R. Thakrar, R. S. Deol, and K. Y. Shah, Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature, Injury, vol. Overall, there is a 28% reported complication rate following tibial tubercle avulsion fracture repair, with the most commonly reported complications being bursitis (56%) and tenderness overlying the tibial tubercle (18%) [8, 13]. The patient was seen 1 week postoperatively and noted moderate pain (6/10) and 0% normal function. 2002 Jan-Feb;22(1):36-40. The mean follow-up period was 39 (range, 23-59) months. Case report and proposed addition to the Watson-Jones classification. However, there were no such reports of patients suffering multiple injuries in addition to a tubercle avulsion fracture. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. China (e-mail: [emailprotected]). PMC The purpose of this study was to determine the long-term outcome with return to play in 8 adolescent basketball players with at least 4 years of postoperative reconditioning. 2010 Nov;19(6):492-6. doi: 10.1097/BPB.0b013e32833cb764. The left knee appearance at 12 months postoperatively was showed in (A), the left knee function at 12 months postoperatively was showed in (B). We describe a case in an adult who suffered a left knee injury due to a fall from height. Unable to load your collection due to an error, Unable to load your delegates due to an error. A. Jakoi, M. Freidl, A. Conclusion: Would you like email updates of new search results? Minimally invasive plate osteosynthesis for open fractures of the proximal tibia. G. Tulic, J. Sopta, M. Bumbasirevic, A. Todorovic, and C. Vucetic, Simultaneous bilateral avulsion fracture of the tibial tubercle in adolescent: a case report, Journal of Pediatric Orthopaedics. Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern. 2. government site. WebThe avulsion fracture of the tibial tuberosity is regarded as a substantial injury to the extensor mechanism as the patellar tendon is attached to the tibial tuberosity. The mean follow-up period was 39 (range, 23-59) months. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. Methods: Int J Surg Case Rep. 2020;71:1-5. doi: 10.1016/j.ijscr.2020.04.029. 10. Anterior-Posterior (a) and lateral (b) X-rays 6 months following operative management demonstrates well-positioned screws with callus formation at the site of injury. Please enable it to take advantage of the complete set of features! Drs Jakoi, Freidl, Old, Javandel, Tom, and Realyvasquez have no relevant financial relationships to disclose. Methods: We reviewed a consecutive series of patients with tibial tubercle fractures treated surgically at 2 level-1 pediatric tertiary care centers over a 12.5-year period. Third, at the same time the patient's skin healed, we recommend the use of a minimally invasive lateral surgical approach to the proximal tibia with extension to the tibial tubercle to allow stable fixation of both fractures so early range of motion can be started to avoid the development of a knee arthrofibrosis and stiffness. eCollection 2020. Tibial tubercle avulsion fractures are a rare injury and can be associated with concomitant soft tissue damage, periosteal damage, and compartment syndrome leading to extensor mechanism disruption, joint laxity, or vascular compromise [6]. Knee Surg Sports Traumatol Arthrosc. Unable to process the form. His knee was in a state of flexion and internal rotation before the traffic accident occurred, and heavy items (such as woods or metal) directly hit him on the left proximal tibial. There was no laxity with varus or valgus stress. Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. 12. Tibial tuberosity fractures (TTF) typically occur in adolescent males by avulsion of the bony insertion of the patellar tendon, caused by sudden violent con-traction of the quadriceps Part B, vol. In this case, our patient presented with a displaced fracture of the tibial tubercle that extended proximally into the joint space (type IIIB). 35, no. Case Rep Orthop. Despite a locking compression plate combined with minimally invasive percutaneous plate osteosynthesis techniques to prevent the blood supply of the fracture from being destroyed, a wound dehiscence and the proximal tibia fractures experienced fragment resorption and sclerosis but ultimately healed. These fractures are relatively uncommon but can have a significant functional effect. Avulsion fractures of the lateral tibial condyle in children. Second, by 3 months, the fibula fracture had almost healed relieving some of stress from the tibial plate and helped to ensure the stability of the construct and provided a better environment for tibial fracture healed. J. M. Brey, J. Conoley, S. T. Canale et al., Tibial tuberosity fractures in adolescents: is a posterior metaphyseal fracture component a predictor of complications? Journal of Pediatric Orthopedics, vol. Under endoscopic visualization, the intramuscular septum was identified and Metzenbaum scissors were used to cut through the fascial compartment beginning in the anterior compartment and extending proximally then distally to the midtibia (Figure 4). e avulsion fracture. No complications were noted. 4, pp. The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. The site is secure. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. On physical examination, he noted no tenderness to palpation of the knee joint, and he had 40 degrees of knee flexion. 45, no. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. 39, no. 94% of patients (248 total) return to their preinjury level at a mean of 28.9 weeks, 98% of patients (250 total) regained full knee range of motion at 22.3 weeks, and 99% of cases (334 out of 336) reported fracture union [8]. This injury has been previously reported with various concomitant injuries, such as compartment syndrome from bleeding into the anterior compartment, vascular injury, patellar tendon avulsion, and meniscal injuryexhibited only with fracture types that extend intra-articularly. This allowed for the insertion of the locked plate and reduction and fixation of the tuberosity. Isolated, noncomminuted tibial tubercle fractures (types IA, IB, and IIA) can be treated with closed reduction for 46 weeks, whereas tibial tubercle fractures that are comminuted or extend intraarticularly should be repaired via open reduction internal fixation [11]. Please try again soon. Surgical Therapy. Types IB, II, and III tibial tubercle fractures require open reduction with internal fixation (ORIF). An anterior approach to the knee is followed over the proximal tibia. Fixation is best accomplished with one or two screws through the tibial tubercle into the proximal tibia. Preoperative lateral X-ray with knee at 30 flexion demonstrated tibial tubercle avulsion fracture extending into the joint space with two primary fragments: (i) anterior tibial plateau and (ii) tibial tubercle. 2022 Mar 10;92(S3):e2021571. Before Careers. As a 14-year old patient at the time of initial consultation, this patient was not skeletally mature at the time of follow-up. eCollection 2020. Result: The overall complication rate was 25.5%, and it was not different between ORIF and CRIF ( P = 0.79). sharing sensitive information, make sure youre on a federal less common pattern of temporal bone fracture (10-30%) the fracture line is perpendicular to the long axis of the petrous Avulsion fracture of the tibial tuberosity is an infrequent injury in adolescents and an extremely rare occurrence in adults. doi: 10.1136/wjps-2020-000169. Comminuted simultaneous bilateral tibial tubercle avulsion fractures: a case report. The remaining 9 fractures were treated with open reduction and internal fixation. Clipboard, Search History, and several other advanced features are temporarily unavailable. Upon presentation to the clinic the following day, he reported mild pain (3/10) and noted no normal function of his leg. Often, percutaneous or open reduction can be performed to maintain motion within the knee. Injury. Previous reports of tibial tubercle avulsion fractures noted patients who had concomitant tendon avulsion, meniscal damage, ligament injury, and vascular compromise. He initially reported to the emergency department and then presented to our practice, where he was diagnosed with a tibial tubercle avulsion fracture with patellar tendon rupture. Results: 32, no. Epub 2003 Oct 3. Avulsion fractures of the tibial tuberosity in the adolescent athlete. 317323, 2018. Ryu RK, Debenham JO. The purpose of this study was to determine the long-term outcome with return to play in 8 adolescent basketball players with at least 4 years of postoperative reconditioning. Three patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. Yue-Dong Hao, Department of Orthopedics, Huaian First People's Hospital, Jiangsu, P.R. Purpose: To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. Extensor mechanism deficit can occur concomitantly in patients with a tibial tubercle avulsion fracture due to patellar tendon rupture [9]. 7. This website uses cookies. A 16 years old male was hurt during school basketball, X-rays displayed avulsion fracture of tibial tuberosity of left knee, the treatment was operative using two cancellous screws, results were good including complete knee mobility and early coming back to school sport at 6 months. may email you for journal alerts and information, but is committed 767769, 2015. In addition to the tubercle fracture, this patient suffered patellar tendon avulsion and subacute compartment syndrome. Some features may aid in distinguishing them. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password. WebThe fracture occurred in 6 out of the 7, after an abrupt tension of the patellar tendon in male sporting adolescents (age 13-17 years). 561566, 2012. Pedrazzini A, Maserati I, Cesaro G, Visigalli A, Casalini D, Bertoni N, Yewo SH, Pogliacomi F. Acta Biomed. World J Pediatr Surg. S. Frey, H. Hosalkar, D. B. Cameron, A. Heath, B. David Horn, and T. J. Ganley, Tibial tuberosity fractures in adolescents, Journal of Children's Orthopaedics, vol. 2021 Feb 10;13(2):e13256. China (e-mail: [emailprotected]). Mirbey J, Besancenot J, Chambers RT, et al. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Thapa S, Glick Y, Smith D, et al. Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. official website and that any information you provide is encrypted Your message has been successfully sent to your colleague. This is the first reported adult case of an avulsion fractures of the tibial tuberosity associated with an open proximal tibial diaphyseal fracture successfully treated by an anatomical reduction and fixation of the avulsion fracture of the tibial tuberosity combined with minimally invasive percutaneous plate osteosynthesis of the proximal tibial diaphyseal fractures. Proximal tibial fractures: current treatment, results, and problems. The lesion was treated with surgical reduction and internal fixation. Federal government websites often end in .gov or .mil. doi: 10.7759/cureus.13256. Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. In a series of 336 tibial avulsion fractures in adolescent patients, there were 8 (2%) patellar or quadriceps tendon avulsions, 6 (2%) meniscal tears, 3 (1%) increased ligamentous laxity, and 12 (4%) compartment syndromes [8]. If physical examination cannot be performed due to cast immobilization or pain, the presence of patella alta on radiographic imaging as well as calcified fragments below the patella may indicate the presence of patellar tendon rupture [7, 9]. In this report, a patient who suffered a tibial tubercle avulsion fracture while jumping and colliding with another player had concomitant patellar tendon avulsion and subacute compartment syndrome that necessitated intraoperative fascial release. By continuing to use this website you are giving consent to cookies being used. 6, pp. In such avulsion fractures, landing on the ground with the knee fully extended after a jump is the most likely cause. 1. Methods: Records of 12 patients aged 11 to 17 (mean, 14) 2019 Jan;39(1):e18-e22. 749759, 2012. Roentgenographic examination revealed a tibial tuberosity avulsion fractures similar to a Type I (Watson-Jones)12 with internal rotation displacement of the fracture fragment combined with a proximal tibial and fibula fracture (Figure 1). D. O. Clarke, S. A. Franklin, and D. E. Wright, Avulsion fracture of the tibial tubercle associated with patellar tendon avulsion, Orthopedics, vol. Intraoperatively, it was noted that extensive bleeding accumulated subacutely within the anterior and lateral compartments. 46, no. Accessibility The high energy nature of the athletic injury is associated with compartment syndrome from bleeding into the anterior compartment, vascular injury [6], patellar tendon avulsion [7], and meniscal injuryexhibited only with fracture types that extend intra-articularly [8]. It was believed that the impending compartment syndrome occurred due to damage to the surrounding bony and muscular tissue. Method: As soon as pain begins to improve, these medications can be stopped. 2004. Federal government websites often end in .gov or .mil. 4046, 2018. This patient is a 14-year-old male, who felt a popping sensation and significant right knee pain while jumping and colliding with another player during a basketball game the previous day. 32, no. The recovery time then depends on healing and how long it takes the athlete to regain knee strength and motion, but return to sports likely takes many months. Compartment syndrome is a potentially devastating injury that can occur with tibial tubercle avulsion fracture due to soft tissue injury or the fractured component damaging the anterior tibial recurrent artery [4, 13]. Rehabilitative exercises and progressive weight bearing were begun according to the imaging results. doi: 10.1136/wjps-2020-000169. 6. (A) Initial lateral x-ray shows a type III tibial tubercle fracture. 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