There was sufficient concern for impending compartment syndrome which led to fascial compartment release. 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). Tibial tubercle avulsion fractures most commonly occur in adolescent boys and usually result from pushing off or landing while jumping. 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 For a complete overview of all the cookies used, please see our privacy policy. They all engaged in sports or active play during the injury. Eight patients injured the right side, 3 the left side, and one both sides. Some features may aid in distinguishing them. 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]. doi: 10.1136/wjps-2020-000169. 2020 Mar 16;2020:8650927. doi: 10.1155/2020/8650927. 32, no. 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. Mirbey J, Besancenot J, Chambers RT, et al. Avulsion fractures of the lateral tibial condyle in children. 6, pp. Krieg JC. Liu, Yu-Ping MD; Hao, Qing-Hai MD; Lin, Feng MD; Wang, Ming-Ming MD; Hao, Yue-Dong MD. Epub 2020 May 8. 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. Avulsion fracture of the tibial tuberosity is an infrequent injury in adolescents and an extremely rare occurrence in adults. 692696, 2012. Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes. Flexion-type fractures of the proximal tibial physis: a report of five cases and review of the literature. Results with return to play at the preinjury level are favorable after treatment of acute tibial avulsion fractures in adolescent basketball players. M. A. Kim JW, Oh CW, Jung WJ, et al. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Vella D, Peretti G, Fra F. One case of fracture of the tibial tuberosity in the adult. 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. 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. 3, pp. Distally, the course of the superficial perineal nerve was identified and the nerve itself was protected during the distal release of the anterior compartment. Unlike previously reported cases, this is the first report of a patient who suffered such an injury with multiple concomitant injuries to the neighboring structures. 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. 39, no. 251259, 2017. Acute tibial tubercle avulsion fractures. J Pediatr Orthop B. Avulsion fractures of the tibial tuberosity in the adolescent athlete. sharing sensitive information, make sure youre on a federal PMC Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern. These fractures are relatively uncommon but can have a significant functional effect. If the fracture is open or comminuted, healing time may take longer. 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. 2004 Mar-Apr;24(2):181-4. doi: 10.1097/00004694-200403000-00009. K AJ, L P. Avulsion fracture of the tibial tubercle in an adult treated with tension-band wiring: a case report. 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. 2005. 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). Disclaimer, National Library of Medicine Careers. M. T. Stepanovich and J. Before A literature search was done to determine the expected clinical outcome of this fracture pattern. Tibial tuberosity avulsion fractures are uncommon. MeSH The .gov means its official. 2005 Dec;91(8):758-67. doi: 10.1016/s0035-1040(05)84487-3. In cases of tibial tubercle avulsion fracture, clinicians should have a high index of suspicion to evaluate for additional injuries that may be present. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. As a 14-year old patient at the time of initial consultation, this patient was not skeletally mature at the time of follow-up. Transverse petrous temporal bone fracture. 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]. 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. WebRecovery time for a tibia fracture typically takes 4-6 months to heal completely. 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. government site. Tibial tubercle fractures frequently require ORIF; Three dimensional imaging may help guide treatment but is not always necessary; Compartment syndrome following tibial tubercle An unusual avulsion fracture of the proximal tibial epiphysis. 2005. He had an active range of motion from 0 to 130 degrees of flexion, and there was no lag with straight leg raise. World J Pediatr Surg. An avulsion fracture to your foot or ankle may require a cast or walking boot. Most injuries in school occur during sport. 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. The overall complication rate was 25.5%, and it was not different between ORIF and CRIF ( P = 0.79). Unable to load your collection due to an error, Unable to load your delegates due to an error. 25, no. These steps were repeated for the midpoint and distal incision sites. WebAbstract. Please try after some time. In such avulsion fractures, landing on the ground with the knee fully extended after a jump is the most likely cause. Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring. 28, no. 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. 35, no. E31E34, 2016. Informed written consent was obtained from the patient). Bolesta MJ, Fitch RD. The .gov means its official. Type II lesions Upon presentation to the clinic the following day, he reported mild pain (3/10) and noted no normal function of his leg. We review the pathophysiology, mechanism, classification, diagnosis, and management of this injury. 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]. For more information, please refer to our Privacy Policy. 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. 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]. 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. Copyright 2022 Elsevier B.V. or its licensors or contributors. Please enable scripts and reload this page. 8600 Rockville Pike Pedrazzini A, Maserati I, Cesaro G, Visigalli A, Casalini D, Bertoni N, Yewo SH, Pogliacomi F. Acta Biomed. This is an open access article distributed under the. WebA 1-month cast immobilisation on an extended knee gives good results in the management of nondisplaced fractures. WebThe purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures. Careers. Tibial Tuberosity Avulsion Fractures (TTAF) are rare, accounting for less than 1% of pediatric fractures [1]. Intraoperative arthroscopic view of Metzenbaum scissors releasing fascial tissue (a) and the site of injury following fascial tissue release (b). 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. This case report reviews the rehabilitation program, and 767769, 2015. The lesion was treated with surgical reduction and internal fixation. He demonstrated 5/5 quadriceps strength with no evidence of an extensor lag. 2020 Sep 16;3(3):e000169. 2007 Feb;15(2):147-9. doi: 10.1007/s00167-006-0164-0. Arkader A, Schur M, Refakis C, Capraro A, Woon R, Choi P. J Pediatr Orthop. 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. Patients with a fracture pattern of the latter form should be evaluated for concomitant patellar ligament disruption, meniscal injury, or compartment syndrome [11]. Nikiforidis PA, Babis GC, Triantafillopoulos IK, Themistocleous GS, Nikolopoulos K. Knee Surg Sports Traumatol Arthrosc. On physical examination, he was nontender to palpation along the joint line. FOIA 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. On the 10th day postinjury the proximal tibial fracture was treated with a locked proximal tibial plate inserted with a minimally invasive technique while the tuberosity fracture was reduced and fixed with 2 lag screws (Figure 2). eCollection 2020. Strong contraction of the quadriceps femoris muscle during leg extension causes failure of the physis at the patellar tendon insertion [5]. The tibial tubercle is the bony attachment on the large bone of the lower leg (tibia) of the big, powerful thigh muscle (quadriceps). The fascial incision was extended posteriorly into the peroneal compartment and then was extended proximally and distally to the midtibia. Disclaimer, National Library of Medicine 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. The incision extended from Gerdy Tubercle to the tibial tuberosity. 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. An 8-centimeter anterior incision was made at the superior aspect of the tibial tubercle and extended distally. (The Ethics Committee of Tengzhou Central People's Hospital approved the study. J Pediatr Orthop. The left knee appearance at 12 months postoperatively was showed in (A), the left knee function at 12 months postoperatively was showed in (B). e561e564, 2016. Avulsion fractures of the tibial tuberosity in the adult are extremely rare with only 3 reported cases.13 It has not been reported with proximal tibial diaphyseal fractures. 561566, 2012. Long-term outcome was excellent in all patients regardless of fracture type. 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. Bauer J, Orendi I, Ladenhauf HN, Neubauer T. Unfallchirurg. 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. This wound was dressed and closed on the 14th postoperative day from fixation and by 6 weeks had finally healed. 2004 Jul;12(4):271-6. doi: 10.1007/s00167-003-0417-0. HHS Vulnerability Disclosure, Help 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. Epub 2003 Oct 3. In this case, suture anchors were placed along the anatomic insertion of the patellar tendon on the anterior tibial cortex. This injury typically occurs in adolescents because the tibial tubercle is still growing and the bone is softer there. 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]. 46, no. The authors have no funding and conflicts of interest to disclose. 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). 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. This website uses cookies. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. Bookshelf At this time, it was recommended that the patient begin gentle active range of motion exercises with extension and light flexion. 2020 Sep 16;3(3):e000169. This site needs JavaScript to work properly. less common pattern of temporal bone fracture (10-30%) the fracture line is perpendicular to the long axis of the petrous 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? China (e-mail: [emailprotected]). Five months postoperatively, the patient reported no pain (0/10) and possessed 95% of his normal function at this time. 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. 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. official website and that any information you provide is encrypted Open reductions and stable screw fixations precede a 3-week immobilisation for displaced fractures. Many cases are misdiagnosed and progress to recurvatum deformity especially in open physis individuals after neglected tibial tuberosity fractures. and transmitted securely. Most injuries in adolescent occur during school sports like volleyball, football or basketball. 9. Additionally, upon presentation to the ER and initial clinic visit, the patient had a stable neurovascular examination, which alleviated concern regarding compartment syndrome. WebAndrew Parker, MD 1120 Raintree Circle, Suite 280 Allen, TX 75013 Phone: (214) 383 9356 Fax: (214) 383 9886 ORIF TIBIAL TUBERCLE PROTOCOL Previous reports of tibial tubercle avulsion fractures noted patients who had concomitant tendon avulsion, meniscal damage, ligament injury, and vascular compromise. These injuries cause significant disruption to school and sport, but fortunately, complications are rare and functional recovery is usually complete. 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 2019 Jan;39(1):e18-e22. An official website of the United States government. your express consent. 8. A. doi: 10.23750/abm.v92iS3.12580. No complications were noted. 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. Avulsion fracture of the tibial tuberosity with articular extension in an adult: a novel method of fixation. TTAF remains rare accounting for <3% of all epiphyseal injuries, it is frequent in teenage boys with open physis during school sport. There was no laxity with varus or valgus stress. 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. Unable to process the form. 2004. On physical examination, incisional sites were clean, dry, and intact and a small fracture blister was noted on the posterior aspect of the kneewhich was cleaned and redressed. doi: 10.1097/BPO.0000000000001269. No risk factors were identified. 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. X-rays will be taken after surgery to assess the position of the implants & the realignment of the bone. Consequently an anatomical reduction and stable fixation is required to assure it heals anatomically. 8600 Rockville Pike [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. doi: 10.23750/abm.v92iS3.12580. 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 While there are various concomitant injuries, patients experiencing more than one concurrent injury with tibial tubercle avulsion fracture have not been reported in the literature. Open reduction and internal fixation using 1 or 2 cancellous bone screws achieved union in all cases. He had full range of motion in left knee after 12 weeks. Tibial tubercle avulsion fractures occur in 0.42.7% of epiphyseal injuries and less than 1% of physeal injuries [1, 2]. He was unable to stand and was sent to the emergency department after the wound was dressed. Ten patients had excellent results and 2 had fair results. Preoperative anteroposterior and lateral film radiographs of the left knee showing tibial tuberosity avulsion fracture and proximal tibial fracture. However, there were no such reports of patients suffering multiple injuries in addition to a tubercle avulsion fracture. An official website of the United States government. Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. Fastest Recovery Time in Pediatric Tibial Tubercle Avulsion Fracture Repair Using SpeedBridge Double-Row Technique: A Case Report Also read: Tibial plateau Federal government websites often end in .gov or .mil. 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. PMC Part B, vol. Data is temporarily unavailable. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. eCollection 2020. 5, pp. Method: If your ankle or hip is fractured, you may need to use crutches Introduction: In minor displacements, such immobilisations follow closed external reductions. Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. Part B, vol. This site needs JavaScript to work properly. Case Rep Orthop. 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. 317323, 2018. Pedrazzini A, Maserati I, Cesaro G, Visigalli A, Casalini D, Bertoni N, Yewo SH, Pogliacomi F. Acta Biomed. 36, no. 469474, 2008. Purpose: To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. What causes this injury? The results were satisfactory: complete functional recovery, resumption of sport at the previous level and absence of recurvatum. Result: Two and a half weeks after surgery, the patient presented to the clinic for evaluation. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. 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. Epub 2005 Oct 24. 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. The patient was placed in a hinged knee brace which was locked in extension. 2022 Mar 10;92(S3):e2021571. We describe a case in an adult who suffered a left knee injury due to a fall from height. In this instance, the patient did not suffer postoperative complications. 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]. Knee Surg Sports Traumatol Arthrosc. Check for errors and try again. The Authors. The main factors of bone healing were as follows, first, the blood supply of proximal of tibia was better than the distal. Methods: Records of 12 patients aged 11 to 17 (mean, 14) 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. 12. 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. EFORT Open Rev. B. Slakey, Combined tibial tubercle avulsion fracture and patellar avulsion fracture: an unusual variant in an adolescent patient, American Journal of Orthopedics, vol. Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. Ma CH, Wu CH, Yu SW, et al. Rev Chir Orthop Reparatrice Appar Mot. Minimally invasive plate osteosynthesis for open fractures of the proximal tibia. 2020 Mar 16;2020:8650927. doi: 10.1155/2020/8650927. A 45-year-old man was hit on the left proximal tibia in a traffic accident. The leg was splinted till the soft tissues were healed and swelling was resolved. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. This allowed for the insertion of the locked plate and reduction and fixation of the tuberosity. By continuing you agree to the use of cookies. Tibial Tubercle Avulsion Fracture. eCollection 2020 May. Your doctor will often prescribe medications for pain-relief for a short period of time after the injury or surgery. 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. 8, pp. Purpose: Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. 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. The mean follow-up period was 39 (range, 23-59) months. 6. The remaining 9 fractures were treated with open reduction and internal fixation. 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). Risk factors, mechanism of injury, and treatment. HHS Vulnerability Disclosure, Help Vyas S, Ebramzadeh E, Behrend C, Silva M, Zionts LE. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. 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]. The distal patellar tendon was completely avulsed through two-thirds of its length. The mean follow-up was of 4.5 years (1.5-7.5 years). 1, pp. Then CT scan is needed to evaluate the fracture extension to the articular joint. Seven patients (low-stress group) had a spontaneous 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). 32, no. Intraoperative arthroscopic view of avulsed fascia and tibialis anterior muscle belly through the site of injury. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. However, close observation in the first 2 weeks is necessary. 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. The reported incidence of patellar tendon rupture ranges from 2%15.7% [8]. government site. 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. 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. 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 patient felt immediate anterior knee and proximal tibial pain, and there was a bleeding laceration (about 8 cm) on the lateral side of the injured proximal tibial. The tendon remained attached to the inferior pole of the patella. 11. 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. Tibial tubercle avulsion fractures (TTAF) are an unusual condition, resulting from a forced extension of the knee opposed to fixed leg. 2010 Nov;19(6):492-6. doi: 10.1097/BPB.0b013e32833cb764. For an avulsion fracture in your pelvis or anywhere else where your healthcare provider cant apply a cast, a short period 6, pp. Rehabilitative exercises and progressive weight bearing were begun according to the imaging results. A medium Hemovac drain was placed along the length of the lateral compartment, exiting in the posterolateral proximal leg. Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern. By continuing to use this website you are giving consent to cookies being used. However, Howarth et al. 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. 2, pp. Nonsurgical treatments may cause fracture malunion, anterior knee pain, and even patellar dislocation. D. O. Clarke, S. A. Franklin, and D. E. Wright, Avulsion fracture of the tibial tubercle associated with patellar tendon avulsion, Orthopedics, vol. 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. 465470, 2011. Georgiou G, Dimitrakopoulou A, Siapkara A, et al. 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. 5. He was discharged home later that day. 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. 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). 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. doi: 10.7759/cureus.13256. Extensor mechanism deficit can occur concomitantly in patients with a tibial tubercle avulsion fracture due to patellar tendon rupture [9]. 2021 Feb 10;13(2):e13256. We used a minimally invasive lateral surgical approach to the tibia and extended to the tibial tubercle to achieve these goals. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. The work cannot be changed in any way or used commercially. The mean follow-up period was 39 (range, 23-59) months. 7. He was placed in a cast and sought a second opinion regarding findings and management. 5, no. Drs Jakoi, Freidl, Old, Javandel, Tom, and Realyvasquez have no relevant financial relationships to disclose. Old, M. Javandel, J. Tom, and J. Realyvasquez, Tibial tubercle avulsion fractures in adolescent basketball players, Orthopedics, vol. Ryu RK, Debenham JO. 4, pp. 1, pp. The authors report 7 cases of acute tibial tubercle avulsion fractures. We use cookies to help provide and enhance our service and tailor content and ads. Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. X-ray is the key to diagnosis. A physical exam was performed but was limited due to pain. Repeat anterior-posterior and lateral X-rays demonstrated a well-reduced tibial tubercle fracture as well as well-positioned and nondisplaced hardware (Figure 6). to maintaining your privacy and will not share your personal information without 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. The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. 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]. China (e-mail: [emailprotected]). 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. After surgery exercise should be restricted for 6 weeks. Bethesda, MD 20894, Web Policies Please enable it to take advantage of the complete set of features! 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. 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. 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. doi: 10.1136/wjps-2020-000169. This scenario raised concern for impending compartment syndrome, and an anterolateral compartment release was planned. 118121, 2010. He was also encouraged to become full weight-bearing with the brace until its removal two months postoperatively. Tension band suture in isolated tibial tubercle avulsion: A case report and review literatures. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. 749759, 2012. This case report is limited in the duration of follow-up. Proximal tibial fractures: current treatment, results, and problems. A medical and endocrinological examination was performed with negative results and no systemic diseases and predisposing factors were found during patient's hospitalization. Tibial tubercle avulsions. 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. 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]. A. Jakoi, M. Freidl, A. Wolters Kluwer Health 3. eCollection 2020. A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. 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. Would you like email updates of new search results? Three 3-centimeter incisions were made along the anterolateral aspect of the leg. Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing [Bony knee injuries in childhood and adolescence]. Case Rep Orthop. On physical examination, he noted no tenderness to palpation of the knee joint, and he had 40 degrees of knee flexion. Some error has occurred while processing your request. Georgiou G, Dimitrakopoulou A, Siapkara A, Kazakos K, Provelengios S, Dounis E. Knee Surg Sports Traumatol Arthrosc. 2020 May 5;5(5):260-267. doi: 10.1302/2058-5241.5.190026. Therefore, this technique may need to be performed under fluoroscopic guidance in order to minimize these risks. Int J Surg Case Rep. 2020;71:1-5. doi: 10.1016/j.ijscr.2020.04.029. A torn patellar tendon was noted in one adolescent having a stage IIIB avulsion fracture. Reference article, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-57064. Nimityongskul P, Montague WL, Anderson LD. Records of 12 patients aged 11 to 17 (mean, 14) years with avulsion fractures of the tibial tubercle presenting to our hospital from April 1998 to September 2004 were studied. 1, pp. 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]. Injury. Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. 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 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. Before MeSH 2019 Jan;122(1):6-16. doi: 10.1007/s00113-018-0590-8. 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. It was believed that the impending compartment syndrome occurred due to damage to the surrounding bony and muscular tissue. 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]. Epub 2006 Aug 18. Intraoperatively, it was noted that extensive bleeding accumulated subacutely within the anterior and lateral compartments. Accessibility He reported that he had no pain (0/10) and had 5% of his normal function at this time. Orthop Clin North Am. 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]. Comminuted simultaneous bilateral tibial tubercle avulsion fractures: a case report. 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. Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Bauer T, Milet A, Odent T, Padovani JP, Glorion C. Rev Chir Orthop Reparatrice Appar Mot. Conclusion: 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. Please enable it to take advantage of the complete set of features! 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. 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. Operative management included ORIF of the tibial tubercle and patellar tendon repair, as well as fascial release which was performed for impending compartment syndrome under arthroscopic guidance. 2, no. 2006 Jan;37(1):57-60. doi: 10.1016/j.injury.2005.05.021. The remaining 9 fractures were treated with open reduction and internal fixation. Longitudinal vs transverse petrous temporal bone fracture. 2005 Dec;91(8):758-67. doi: 10.1016/s0035-1040(05)84487-3. The injuries were managed with an open reduction internal fixation (ORIF) of the tibial tubercle and distal patellar tendon repair. 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. 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