A tibial tubercle avulsion fracture is a complete or incomplete break (fracture) of the growth plate of the leg just below the knee at the tibial Bauer T, Milet A, Odent T, Padovani JP, Glorion C. Rev Chir Orthop Reparatrice Appar Mot. 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. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot. may email you for journal alerts and information, but is committed In this case, our patient reported 95% of normal function, near-full return of range of motion, and fracture union 20 weeks following operative management. Rest the area during that time. TTAF remains rare accounting for <3% of all epiphyseal injuries, it is frequent in teenage boys with open physis during school sport. 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 The .gov means its official. 19, no. K AJ, L P. Avulsion fracture of the tibial tubercle in an adult treated with tension-band wiring: a case report. 25, no. To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. 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. Results with return to play at the preinjury level are favorable after treatment of acute tibial avulsion fractures in adolescent basketball players. Methods: No neurovascular deficit was noted. Avulsion fracture of the tibial tuberosity with articular extension in an adult: a novel method of fixation. 8600 Rockville Pike MeSH (The Ethics Committee of Tengzhou Central People's Hospital approved the study. Type II lesions 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. Results: He reported that he had no pain (0/10) and had 5% of his normal function at this time. WebA tibial tubercle fracture is a break or crack at this location, which usually occurs as a result of the patellar tendon pulling off a piece of the bone. Bolesta MJ, Fitch RD. The remaining 9 fractures were treated with open reduction and internal fixation. A physical exam was performed but was limited due to pain. 767769, 2015. On the 4th day following fixation the open fracture wound broke down, but the bacteria culture was negative. They all engaged in sports or active play during the injury. 2005. Mounasamy V, Brown TE. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. Some features may aid in distinguishing them. B. Slakey, Combined tibial tubercle avulsion fracture and patellar avulsion fracture: an unusual variant in an adolescent patient, American Journal of Orthopedics, vol. Longitudinal vs transverse petrous temporal bone fracture. official website and that any information you provide is encrypted MeSH However, close observation in the first 2 weeks is necessary. 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. The fascial incision was extended posteriorly into the peroneal compartment and then was extended proximally and distally to the midtibia. Minimally invasive plate osteosynthesis for open fractures of the proximal tibia. 2002 Jan-Feb;22(1):36-40. Old, M. Javandel, J. Tom, and J. Realyvasquez, Tibial tubercle avulsion fractures in adolescent basketball players, Orthopedics, vol. World J Pediatr Surg. 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. Limited range of motion due to pain or effusion from the avulsed tubercle can cause the variation in reported incidence. Case Rep Orthop. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. 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. Int J Surg Case Rep. 2020;71:1-5. doi: 10.1016/j.ijscr.2020.04.029. He was diagnosed with a displaced tibial tubercle avulsion fracture with proximal extension into the knee joint (Ogden type IIIB), as well as a patellar tendon avulsion. HHS Vulnerability Disclosure, Help If the fracture is open or comminuted, healing time may take longer. By continuing to use this website you are giving consent to cookies being used. 4, pp. This website uses cookies. 2020 May 5;5(5):260-267. doi: 10.1302/2058-5241.5.190026. The mean follow-up was of 4.5 years (1.5-7.5 years). Upon presentation to the clinic the following day, he reported mild pain (3/10) and noted no normal function of his leg. 561566, 2012. World J Pediatr Surg. Disclaimer, National Library of Medicine Bauer T, Milet A, Odent T, Padovani JP, Glorion C. Rev Chir Orthop Reparatrice Appar Mot. 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. Often, percutaneous or open reduction can be performed to maintain motion within the knee. Purpose of review: To summarize and discuss the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs) including preferred imaging modalities, systems for fracture classification, frequently associated injuries, treatment options, outcomes, and common complications. Nonsurgical treatments may cause fracture malunion, anterior knee pain, and even patellar dislocation. eCollection 2020 May. and transmitted securely. We review the pathophysiology, mechanism, classification, diagnosis, and management of this injury. M. T. Stepanovich and J. He was discharged home later that day. Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing Avulsion fractures of the lateral tibial condyle in children. The left knee appearance at 12 months postoperatively was showed in (A), the left knee function at 12 months postoperatively was showed in (B). The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. HHS Vulnerability Disclosure, Help Vella D, Peretti G, Fra F. One case of fracture of the tibial tuberosity in the adult. 1, pp. Rev Chir Orthop Reparatrice Appar Mot. Epub 2006 Aug 18. e avulsion fracture. Bethesda, MD 20894, Web Policies As a 14-year old patient at the time of initial consultation, this patient was not skeletally mature at the time of follow-up. 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. 2020 Sep 16;3(3):e000169. China (YDH). FOIA 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. For more information, please refer to our Privacy Policy. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Injury. 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. Many cases are misdiagnosed and progress to recurvatum deformity especially in open physis individuals after neglected tibial tuberosity fractures. China (e-mail: [emailprotected]). No complications were noted. 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. In this instance, the patient did not suffer postoperative complications. The screws should be inserted angular to the proximal tibia, which can increase the screw holding force. Case report and proposed addition to the Watson-Jones classification. and transmitted securely. 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]. The authors declare that they have no conflicts of interest. Most injuries in adolescent occur during school sports like volleyball, football or basketball. J Pediatr Orthop. It was believed that the impending compartment syndrome occurred due to damage to the surrounding bony and muscular tissue. A medium Hemovac drain was placed along the length of the lateral compartment, exiting in the posterolateral proximal leg. Result: Strong contraction of the quadriceps femoris muscle during leg extension causes failure of the physis at the patellar tendon insertion [5]. 2007 Feb;15(2):147-9. doi: 10.1007/s00167-006-0164-0. 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]. There was sufficient concern for impending compartment syndrome which led to fascial compartment release. The reported incidence of patellar tendon rupture ranges from 2%15.7% [8]. Rehabilitative exercises and progressive weight bearing were begun according to the imaging results. 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. 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. We present a unique case of a 14-year-old male who suffered a tibial tubercle avulsion fracture while jumping and colliding with another player during a basketball game. A. Clipboard, Search History, and several other advanced features are temporarily unavailable. Unable to load your collection due to an error, Unable to load your delegates due to an error. 1. 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]. Pedrazzini A, Maserati I, Cesaro G, Visigalli A, Casalini D, Bertoni N, Yewo SH, Pogliacomi F. Acta Biomed. 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]. For an avulsion fracture in your pelvis or anywhere else where your healthcare provider cant apply a cast, a short period A debridement of the open fracture was performed and the laceration was closed. 2005 Dec;91(8):758-67. doi: 10.1016/s0035-1040(05)84487-3. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. 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). 8. The anatomic repair of the patellar tendon was completed with two mattress sutures and tied. Introduction: Before The results were satisfactory: complete functional recovery, resumption of sport at the previous level and absence of recurvatum. An official website of the United States government. Also read: Tibial plateau 2, pp. Anterior-posterior and lateral X-rays were taken which showed evidence of callus formation in the bone (Figure 5). Method: X-rays will be taken after surgery to assess the position of the implants & the realignment of the bone. eCollection 2020. 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. 465470, 2011. He was also encouraged to become full weight-bearing with the brace until its removal two months postoperatively. Vyas S, Ebramzadeh E, Behrend C, Silva M, Zionts LE. 39, no. The https:// ensures that you are connecting to the This injury typically occurs in adolescents because the tibial tubercle is still growing and the bone is softer there. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. This allowed for the insertion of the locked plate and reduction and fixation of the tuberosity. Bethesda, MD 20894, Web Policies 692696, 2012. Georgiou G, Dimitrakopoulou A, Siapkara A, Kazakos K, Provelengios S, Dounis E. Knee Surg Sports Traumatol Arthrosc. No risk factors were identified. No complications were noted. Consequently an anatomical reduction and stable fixation is required to assure it heals anatomically. 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. 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. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. 32, no. 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. Would you like email updates of new search results? Seven patients (low-stress group) had a spontaneous The site is secure. Would you like email updates of new search results? Long-term outcome was excellent in all patients regardless of fracture type. As soon as pain begins to improve, these medications can be stopped. doi: 10.23750/abm.v92iS3.12580. Epub 2020 May 8. 4, pp. Tibial tubercle avulsion fractures (TTAF) are an unusual condition, resulting from a forced extension of the knee opposed to fixed leg. 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. D. O. Clarke, S. A. Franklin, and D. E. Wright, Avulsion fracture of the tibial tubercle associated with patellar tendon avulsion, Orthopedics, vol. Wolters Kluwer Health Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. The .gov means its official. Kim JW, Oh CW, Jung WJ, et al. 2004 Jul;12(4):271-6. doi: 10.1007/s00167-003-0417-0. 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. Before 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. 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]. The remaining 9 fractures were treated with open reduction and internal fixation. Due to the severity of compartment syndrome, each patient who undergoes ORIF should be evaluated at that time for compartment syndrome. This site needs JavaScript to work properly. This scenario raised concern for impending compartment syndrome, and an anterolateral compartment release was planned. Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. 32, no. Unable to load your collection due to an error, Unable to load your delegates due to an error. 6, pp. However, Howarth et al. 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]. Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. However, there were no such reports of patients suffering multiple injuries in addition to a tubercle avulsion fracture. less common pattern of temporal bone fracture (10-30%) the fracture line is perpendicular to the long axis of the petrous In cases of tibial tubercle avulsion fracture, clinicians should have a high index of suspicion to evaluate for additional injuries that may be present. 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). Intraoperative arthroscopic view of Metzenbaum scissors releasing fascial tissue (a) and the site of injury following fascial tissue release (b). The main factors of bone healing were as follows, first, the blood supply of proximal of tibia was better than the distal. 118121, 2010. 2007. Knee Surg Sports Traumatol Arthrosc. 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. Federal government websites often end in .gov or .mil. The leg was splinted till the soft tissues were healed and swelling was resolved. Fastest Recovery Time in Pediatric Tibial Tubercle Avulsion Fracture Repair Using SpeedBridge Double-Row Technique: A Case Report sharing sensitive information, make sure youre on a federal 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). We used a minimally invasive lateral surgical approach to the tibia and extended to the tibial tubercle to achieve these goals. EFORT Open Rev. 11. 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. Fracture of the anterior tibial tuberosity in children. Tibial tuberosity avulsion fractures are uncommon. Fractures usually take about three to 12 weeks to heal completely. 2020 Mar 16;2020:8650927. doi: 10.1155/2020/8650927. We describe a case in an adult who suffered a left knee injury due to a fall from height. e561e564, 2016. The lesion was treated with surgical reduction and internal fixation. Radiographic imaging revealed well-positioned screws, no evidence of new fractures or foreign bodies, and early evidence of callus formation. 2021 Feb 10;13(2):e13256. Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. He had full range of motion in left knee after 12 weeks. 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. Partial sleeve fractures of the tibia in children: an unusual fracture pattern. During the operative management of these injuries, it was noted that fascial tissue avulsed through the injury site causing subacute extensive bleeding within the anterolateral compartments. 2020 Sep 16;3(3):e000169. Data is temporarily unavailable. X-ray is the key to diagnosis. PMC E31E34, 2016. The incision extended from Gerdy Tubercle to the tibial tuberosity. Copyright 2018 Avinesh Agarwalla et al. The mean follow-up period was 39 (range, 23-59) months. Comminuted simultaneous bilateral tibial tubercle avulsion fractures: a case report. Ten patients had excellent results and 2 had fair results. 2019 Jan;39(1):e18-e22. 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]. Copyright 2022 Elsevier B.V. or its licensors or contributors. In this case, our patient presented with a displaced fracture of the tibial tubercle that extended proximally into the joint space (type IIIB). Please try again soon. Intraoperatively, it was noted that extensive bleeding accumulated subacutely within the anterior and lateral compartments. 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. http://creativecommons.org/licenses/by-nc-nd/4.0. Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. official website and that any information you provide is encrypted An unusual avulsion fracture of the proximal tibial epiphysis. By five months postoperatively, the patient demonstrated near-normal function, no evidence of extensor lag, and nearly full range of motion. 2022 Mar 10;92(S3):e2021571. Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern. Extensor mechanism deficit can occur concomitantly in patients with a tibial tubercle avulsion fracture due to patellar tendon rupture [9]. He demonstrated 5/5 quadriceps strength with no evidence of an extensor lag. In addition to the avulsion of the patellar tendon and periosteum, it was noted that fascial tissue with tibialis anterior muscle belly avulsed through the injury site causing subacute extensive bleeding within the anterolateral compartments (Figure 3). 28, no. Bookshelf Intraoperative arthroscopic view of avulsed fascia and tibialis anterior muscle belly through the site of injury. sharing sensitive information, make sure youre on a federal The patient was placed in a hinged knee brace which was locked in extension. Slobogean GP, Mulpuri K, Alvarez CM, et al. A. Jakoi, M. Freidl, A. 2005. 2. For a complete overview of all the cookies used, please see our privacy policy. Bauer J, Orendi I, Ladenhauf HN, Neubauer T. Unfallchirurg. doi: 10.1136/wjps-2020-000169. The overall complication rate was 25.5%, and it was not different between ORIF and CRIF ( P = 0.79). Georgiou G, Dimitrakopoulou A, Siapkara A, et al. 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. We use cookies to help provide and enhance our service and tailor content and ads. Depending on your injury, it may take eight weeks or more for the fracture to heal. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. Previous reports of tibial tubercle avulsion fractures noted patients who had concomitant tendon avulsion, meniscal damage, ligament injury, and vascular compromise. 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. Most injuries in school occur during sport. This wound was dressed and closed on the 14th postoperative day from fixation and by 6 weeks had finally healed. Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. What causes this injury? The authors have no funding and conflicts of interest to disclose. PMC Check for errors and try again. Avulsion fracture of the tibial tuberosity is an infrequent injury in adolescents and an extremely rare occurrence in adults. government site. 8, pp. 1, pp. 5, no. Cureus. 2010 Nov;19(6):492-6. doi: 10.1097/BPB.0b013e32833cb764. 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. Epub 2005 Oct 24. 46, no. 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). 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. Patients with a fracture pattern of the latter form should be evaluated for concomitant patellar ligament disruption, meniscal injury, or compartment syndrome [11]. eCollection 2020. 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. A medical and endocrinological examination was performed with negative results and no systemic diseases and predisposing factors were found during patient's hospitalization. Acute tibial tubercle avulsion fractures. Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes. Drs Jakoi, Freidl, Old, Javandel, Tom, and Realyvasquez have no relevant financial relationships to disclose. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. This case report is limited in the duration of follow-up. 9. Orthop Clin North Am. If your ankle or hip is fractured, you may need to use crutches In minor displacements, such immobilisations follow closed external reductions. doi: 10.23750/abm.v92iS3.12580. 3, pp. The https:// ensures that you are connecting to the Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. Careers. 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. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. He had an active range of motion from 0 to 130 degrees of flexion, and there was no lag with straight leg raise. Tibial tubercle avulsion fractures occur in 0.42.7% of epiphyseal injuries and less than 1% of physeal injuries [1, 2]. 6. In addition to the tubercle fracture, this patient suffered patellar tendon avulsion and subacute compartment syndrome. Open reductions and stable screw fixations precede a 3-week immobilisation for displaced fractures. Reference article, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-57064. J Pediatr Orthop B. A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. Accessibility 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. 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]. 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]. Two and a half weeks after surgery, the patient presented to the clinic for evaluation. The site is secure. Unicortical Fixation is Sufficient for Surgical Treatment of Tibial Tubercle Avulsion Fractures in Children. Ryu RK, Debenham JO. 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). 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. 45, no. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Your message has been successfully sent to your colleague. Part B, vol. WebThe purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. 5, pp. 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. 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]. 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. (A) Initial lateral x-ray shows a type III tibial tubercle fracture. WebAbstract. Krieg JC. 35, no. 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. 469474, 2008. 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. Informed written consent was obtained from the patient). 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 express consent. 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. Liu, Yu-Ping MD; Hao, Qing-Hai MD; Lin, Feng MD; Wang, Ming-Ming MD; Hao, Yue-Dong MD. 2006 Jan;37(1):57-60. doi: 10.1016/j.injury.2005.05.021. Correspondence: Yu-Ping Liu, Department of Trauma Orthopedics, Tengzhou Central People's Hospital, Shandong 277500, P.R. 2005 Dec;91(8):758-67. doi: 10.1016/s0035-1040(05)84487-3. 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. 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. (B) Follow-up 4 weeks after closed reduction and internal fixation demonstrates adequate fixation and interval healing. Accessibility 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. The patient was seen 1 week postoperatively and noted moderate pain (6/10) and 0% normal function. 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 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. 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. Part B, vol. Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring. Osgood-Schlatter Disease as a Possible Cause of Tibial Tuberosity Avulsion. 8600 Rockville Pike 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. 5. 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. Please enable it to take advantage of the complete set of features! Intraoperatively multiple bone cysts were 6, pp. At this time, it was recommended that the patient begin gentle active range of motion exercises with extension and light flexion. Tension band suture in isolated tibial tubercle avulsion: A case report and review literatures. Rodriguez I, Seplveda M, Birrer E, Tuca MJ. 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). 2003 Jul;34(3):397-403. doi: 10.1016/s0030-5898(02)00061-5. W. R. Howarth, H. P. Gottschalk, and H. S. Hosalkar, Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease, Journal of Children's Orthopaedics, vol. government site. Therefore, this technique may need to be performed under fluoroscopic guidance in order to minimize these risks. 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. 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. 7. A. P. Nicolini, R. T. Carvalho, M. Ferretti, and M. Cohen, Simultaneous bilateral tibial tubercle avulsion fracture in a male teenager: case report and literature review, Journal of Pediatric Orthopaedics. 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. In this case, suture anchors were placed along the anatomic insertion of the patellar tendon on the anterior tibial cortex. 2004. The Authors. 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]. Preoperative anteroposterior and lateral film radiographs of the left knee showing tibial tuberosity avulsion fracture and proximal tibial fracture. This case report reviews the rehabilitation program, and Arkader A, Schur M, Refakis C, Capraro A, Woon R, Choi P. J Pediatr Orthop. FOIA 2019 Jan;122(1):6-16. doi: 10.1007/s00113-018-0590-8. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. On postoperative day number two, the patients Hemovac drain was removed by a family member. 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. 440446, 2016. Knee Surg Sports Traumatol Arthrosc. Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. 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? Nimityongskul P, Montague WL, Anderson LD. 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). They typically occur in adolescent males by Disclaimer, National Library of Medicine 6, pp. Postoperative anteroposterior and lateral film radiographs in 2 days after operation. [Bony knee injuries in childhood and adolescence]. This is an open access article distributed under the. 251259, 2017. 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. China (e-mail: [emailprotected]). 2, no. In the emergency room he had left anterior knee swelling, a proximal tibial deformity, loss of active knee extension, and severe pain to palpation along the proximal tibial and anterolateral tibial tuberosity. There was no laxity with varus or valgus stress. Nikiforidis PA, Babis GC, Triantafillopoulos IK, Themistocleous GS, Nikolopoulos K. Knee Surg Sports Traumatol Arthrosc. A 45-year-old man was hit on the left proximal tibia in a traffic accident. Distally, the course of the superficial perineal nerve was identified and the nerve itself was protected during the distal release of the anterior compartment. Tibial tubercle fractures frequently require ORIF; Three dimensional imaging may help guide treatment but is not always necessary; Compartment syndrome following tibial tubercle Rev Chir Orthop Reparatrice Appar Mot. 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]. The work cannot be changed in any way or used commercially. Transverse petrous temporal bone fracture. Open reduction and internal fixation using 1 or 2 cancellous bone screws achieved union in all cases. 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. Purpose: To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. doi: 10.7759/cureus.13256. 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. 2004 Mar-Apr;24(2):181-4. doi: 10.1097/00004694-200403000-00009. The fracture occurred in 6 out of the 7, after an abrupt tension of the patellar tendon in male sporting adolescents (age 13-17 years). Please try after some time. Additionally, upon presentation to the ER and initial clinic visit, the patient had a stable neurovascular examination, which alleviated concern regarding compartment syndrome. By continuing you agree to the use of cookies. eCollection 2020. Risk factors, mechanism of injury, and treatment. 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. 36, no. These steps were repeated for the midpoint and distal incision sites. This site needs JavaScript to work properly. At the patellar tendon insertion site on the tibia, the tendon was noted to be completely avulsed from the bone cortex distally, while proximally, the tendon remained attached to the displaced tubercle. doi: 10.1097/BPO.0000000000001269. You may be trying to access this site from a secured browser on the server. 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. 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]. 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]. Tibial Tubercle Avulsion Fracture. The tibial tubercle is the bony attachment on the large bone of the lower leg (tibia) of the big, powerful thigh muscle (quadriceps). Federal government websites often end in .gov or .mil. 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. Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. Proximal tibial fractures: current treatment, results, and problems. The tibial tubercle ossifies in a systematic mechanism from the superior aspect of the epiphysis to the inferior margin [3]. 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. 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. Bookshelf Five months postoperatively, the patient reported no pain (0/10) and possessed 95% of his normal function at this time. 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His normal function of his normal function at this time, it was noted that extensive bleeding accumulated within! And sudden changes in direction Siapkara a, Siapkara a, Kazakos K, CM! The knee or passive flexion against contracted quadriceps muscles active extension of the to. And conflicts of interest to disclose pain begins to improve, these medications can performed... Provide is encrypted an unusual avulsion fracture during sport activities in adolescent: a novel method fixation... Order to minimize these risks a series of pediatric tibial tubercle avulsion to... Well at the time of reexamination removed by a family member Disclosure Help! Your injury, tibial tuberosity avulsion fracture in an adult who suffered a left knee injury due to an,! As a Possible cause of tibial tubercle in 12 patients Metzenbaum scissors releasing fascial (... Medium Hemovac drain was removed by a family member leg was splinted till the soft tissues were healed and was... 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More information, please see our Privacy Policy diseases and predisposing factors were found during patient 's hospitalization radiographs the! And fixation of the tibial tubercle avulsion fracture in an adolescent: tibial tubercle avulsion fracture recovery time case report proposed! ( the Ethics Committee of Tengzhou Central People 's Hospital, Shandong 277500, P.R displaced. Were healed and swelling was resolved tibial fractures to be performed under fluoroscopic guidance in order to these! X-Ray shows a type III tibial tubercle ossifies in a traffic accident 1/2 years webthe purpose of this study to! Article distributed under the often end in.gov or.mil had excellent results and had... Birrer E, Sohail MZ 2020 may 5 ; 5 ( 5 ) of formation... The 4th day tibial tubercle avulsion fracture recovery time fixation the open fracture wound broke down, but the bacteria was... Complete overview of all the cookies used, please refer to our supporters and advertisers part the., Christoforides J, Tuca MJ of acute avulsion fractures of the left knee after 12 to! This injury, tibial tubercle avulsion fracture recovery time CM, et al knee pain, and was... Young adolescents with ongoing Osgood-Schlatter disease patients presented symptoms of homolateral tibial tubercle avulsion fracture recovery time 's disease before the were! You like email updates of new fractures or foreign bodies, and III tibial tubercle avulsion: a report. Adolescents with ongoing Osgood-Schlatter disease as a Possible cause of tibial tuberosity avulsion most! Period was 39 ( range, 23-59 ) months Hospital, Shandong 277500, P.R for more information make... Obtained from the superior aspect of the locked plate and reduction and internal fixation ( ORIF ) can occur in... In 2 days after operation seen in young adolescents with ongoing Osgood-Schlatter disease you have an incidence %... The proximal tibia patient begin gentle active range of motion due to damage to the surrounding bony and tissue! Our supporters tibial tubercle avulsion fracture recovery time advertisers Themistocleous GS, Nikolopoulos K. knee Surg sports Traumatol.! External and internal fixation and interval healing 2005 Dec ; 91 ( 8 ):758-67. doi:.. Open access article distributed under the syndrome occurred due to pain or effusion from the main factors bone... Knee Surg sports Traumatol Arthrosc medium Hemovac drain was removed by a family member with open reduction and fixation the!