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. A medium Hemovac drain was placed along the length of the lateral compartment, exiting in the posterolateral proximal leg. 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. and transmitted securely. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. EFORT Open Rev. 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. Liu, Yu-Ping MD; Hao, Qing-Hai MD; Lin, Feng MD; Wang, Ming-Ming MD; Hao, Yue-Dong MD. Kim JW, Oh CW, Jung WJ, et al. The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. Vyas S, Ebramzadeh E, Behrend C, Silva M, Zionts LE. Repeat anterior-posterior and lateral X-rays demonstrated a well-reduced tibial tubercle fracture as well as well-positioned and nondisplaced hardware (Figure 6). Introduction: Reference article, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-57064. An official website of the United States government. Unable to load your collection due to an error, Unable to load your delegates due to an error. After surgery exercise should be restricted for 6 weeks. (A) Initial lateral x-ray shows a type III tibial tubercle fracture. J Pediatr Orthop. Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. 2020 Mar 16;2020:8650927. doi: 10.1155/2020/8650927. Careers. 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]. The anatomic repair of the patellar tendon was completed with two mattress sutures and tied. The .gov means its official. These steps were repeated for the midpoint and distal incision sites. WebRecovery time for a tibia fracture typically takes 4-6 months to heal completely. Clipboard, Search History, and several other advanced features are temporarily unavailable. Therefore, this technique may need to be performed under fluoroscopic guidance in order to minimize these risks. The mean follow-up was of 4.5 years (1.5-7.5 years). You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. A medical and endocrinological examination was performed with negative results and no systemic diseases and predisposing factors were found during patient's hospitalization. 45, no. 440446, 2016. 6, pp. A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. Bethesda, MD 20894, Web Policies e561e564, 2016. A physical exam was performed but was limited due to pain. 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]. 2002 Jan-Feb;22(1):36-40. 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. 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. Case report and proposed addition to the Watson-Jones classification. 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. 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). 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. Many cases are misdiagnosed and progress to recurvatum deformity especially in open physis individuals after neglected tibial tuberosity fractures. 2019 Jan;122(1):6-16. doi: 10.1007/s00113-018-0590-8. e avulsion fracture. Most injuries in school occur during sport. 2020 Sep 16;3(3):e000169. 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. 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. 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. Methods: By five months postoperatively, the patient demonstrated near-normal function, no evidence of extensor lag, and nearly full range of motion. sharing sensitive information, make sure youre on a federal 28, no. Often, percutaneous or open reduction can be performed to maintain motion within the knee. Mirbey J, Besancenot J, Chambers RT, et al. The tendon remained attached to the inferior pole of the patella. Copyright 2018 Avinesh Agarwalla et al. http://creativecommons.org/licenses/by-nc-nd/4.0. 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. 8. 12. Purpose: 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. The patient was placed in a hinged knee brace which was locked in extension. Due to the severity of compartment syndrome, each patient who undergoes ORIF should be evaluated at that time for compartment syndrome. Nikiforidis PA, Babis GC, Triantafillopoulos IK, Themistocleous GS, Nikolopoulos K. Knee Surg Sports Traumatol Arthrosc. 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. 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. 4046, 2018. Vella D, Peretti G, Fra F. One case of fracture of the tibial tuberosity in the adult. 749759, 2012. Disclaimer, National Library of Medicine WebAndrew Parker, MD 1120 Raintree Circle, Suite 280 Allen, TX 75013 Phone: (214) 383 9356 Fax: (214) 383 9886 ORIF TIBIAL TUBERCLE PROTOCOL 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. Type II lesions In this instance, the patient did not suffer postoperative complications. Intraoperative arthroscopic view of avulsed fascia and tibialis anterior muscle belly through the site of injury. 2020 May 5;5(5):260-267. doi: 10.1302/2058-5241.5.190026. Krieg JC. Comminuted simultaneous bilateral tibial tubercle avulsion fractures: a case report. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. Slobogean GP, Mulpuri K, Alvarez CM, et al. Bookshelf The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. J Pediatr Orthop B. Accessibility J Pediatr Orthop. Published by Wolters Kluwer Health, Inc. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Thapa S, Glick Y, Smith D, et al. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. 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). Results with return to play at the preinjury level are favorable after treatment of acute tibial avulsion fractures in adolescent basketball players. TTAF remains rare accounting for <3% of all epiphyseal injuries, it is frequent in teenage boys with open physis during school sport. 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. However, close observation in the first 2 weeks is necessary. 7. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. 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 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]. On physical examination, he was nontender to palpation along the joint line. These injuries cause significant disruption to school and sport, but fortunately, complications are rare and functional recovery is usually complete. [Bony knee injuries in childhood and adolescence]. 2022 Mar 10;92(S3):e2021571. This allowed for the insertion of the locked plate and reduction and fixation of the tuberosity. 767769, 2015. Unicortical Fixation is Sufficient for Surgical Treatment of Tibial Tubercle Avulsion Fractures in Children. 6. Nimityongskul P, Montague WL, Anderson LD. 2020 Sep 16;3(3):e000169. M. A. Avulsion fractures of the tibial tubercle are uncommon school sports injuries. Careers. Anterior-posterior and lateral X-rays were taken which showed evidence of callus formation in the bone (Figure 5). This scenario raised concern for impending compartment syndrome, and an anterolateral compartment release was planned. If physical examination cannot be performed due to cast immobilization or pain, the presence of patella alta on radiographic imaging as well as calcified fragments below the patella may indicate the presence of patellar tendon rupture [7, 9]. In 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]. The .gov means its official. MeSH Tension band suture in isolated tibial tubercle avulsion: A case report and review literatures. 2005. Avulsion occurs with the violent active extension of the knee or passive flexion against contracted quadriceps muscles. Although an acute injury, tibial tuberosity avulsion is most frequently seen in young adolescents with ongoing Osgood-Schlatter disease. Avulsion fractures of the lateral tibial condyle in children. Please enable it to take advantage of the complete set of features! Rev Chir Orthop Reparatrice Appar Mot. Eight patients injured the right side, 3 the left side, and one both sides. 2. Open reduction and internal fixation using 1 or 2 cancellous bone screws achieved union in all cases. Mounasamy V, Brown TE. They typically occur in adolescent males by Avulsion fractures of the tibial tuberosity in the adolescent athlete. In cases of tibial tubercle avulsion fracture, clinicians should have a high index of suspicion to evaluate for additional injuries that may be present. sharing sensitive information, make sure youre on a federal Unable to process the form. 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. We use cookies to help provide and enhance our service and tailor content and ads. This site needs JavaScript to work properly. The fascial incision was extended posteriorly into the peroneal compartment and then was extended proximally and distally to the midtibia. A debridement of the open fracture was performed and the laceration was closed. Before 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]. Knee Surg Sports Traumatol Arthrosc. 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. Yue-Dong Hao, Department of Orthopedics, Huaian First People's Hospital, Jiangsu, P.R. 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. 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. Federal government websites often end in .gov or .mil. doi: 10.23750/abm.v92iS3.12580. He was placed in a cast and sought a second opinion regarding findings and management. They all engaged in sports or active play during the injury. Tibial tubercle avulsion fractures (TTAF) are an unusual condition, resulting from a forced extension of the knee opposed to fixed leg. The mean follow-up period was 39 (range, 23-59) months. Tibial tubercle avulsion fractures most commonly occur in adolescent boys and usually result from pushing off or landing while jumping. Injury. 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). 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. to maintaining your privacy and will not share your personal information without Rodriguez I, Seplveda M, Birrer E, Tuca MJ. Bookshelf 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. This wound was dressed and closed on the 14th postoperative day from fixation and by 6 weeks had finally healed. 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 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. Your message has been successfully sent to your colleague. 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). Two and a half weeks after surgery, the patient presented to the clinic for evaluation. 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 https:// ensures that you are connecting to the 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. Open reductions and stable screw fixations precede a 3-week immobilisation for displaced fractures. Bethesda, MD 20894, Web Policies There was sufficient concern for impending compartment syndrome which led to fascial compartment release. 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). Postoperative anteroposterior and lateral film radiographs in 12 months showed that fractures eventually healed. Pedrazzini A, Maserati I, Cesaro G, Visigalli A, Casalini D, Bertoni N, Yewo SH, Pogliacomi F. Acta Biomed. Tibial tubercle avulsion fractures can cause disruption to the growth plate which can cause skeletal deformities such as genu recurvatum or limb-length discrepancy, which can present in 4% and 5% of cases, respectively [8]. In this case, our patient presented with a displaced fracture of the tibial tubercle that extended proximally into the joint space (type IIIB). 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. Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. 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. HHS Vulnerability Disclosure, Help 469474, 2008. 2005. 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. 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. 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 25, no. 10. 32, no. He was discharged home later that day. eCollection 2020. This is an open access article distributed under the. The reported incidence of patellar tendon rupture ranges from 2%15.7% [8]. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. 2019 Jan;39(1):e18-e22. doi: 10.1136/wjps-2020-000169. Partial sleeve fractures of the tibia in children: an unusual fracture pattern. 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). Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. 1, pp. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. 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. The leg was splinted till the soft tissues were healed and swelling was resolved. On physical examination, he noted no tenderness to palpation of the knee joint, and he had 40 degrees of knee flexion. The tibial tubercle ossifies in a systematic mechanism from the superior aspect of the epiphysis to the inferior margin [3]. What causes this injury? Conclusion: An unusual avulsion fracture of the proximal tibial epiphysis. We used a minimally invasive lateral surgical approach to the tibia and extended to the tibial tubercle to achieve these goals. 8, pp. 251259, 2017. Check for errors and try again. 5, no. In such avulsion fractures, landing on the ground with the knee fully extended after a jump is the most likely cause. Please try after some time. WebThe purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures. 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. On postoperative day number two, the patients Hemovac drain was removed by a family member. A. Jakoi, M. Freidl, A. Intraoperative arthroscopic view of Metzenbaum scissors releasing fascial tissue (a) and the site of injury following fascial tissue release (b). Intraoperatively multiple bone cysts were 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. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. He had full range of motion in left knee after 12 weeks. Knee Surg Sports Traumatol Arthrosc. We use cookies on this site to enhance your user experience. 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. To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. 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. Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern. In minor displacements, such immobilisations follow closed external reductions. Avulsion fracture of the tibial tuberosity is an infrequent injury in adolescents and an extremely rare occurrence in adults. your express consent. 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. Flexion-type fractures of the proximal tibial physis: a report of five cases and review of the literature. 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. 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). Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring. 2010 Nov;19(6):492-6. doi: 10.1097/BPB.0b013e32833cb764. official website and that any information you provide is encrypted Would you like email updates of new search results? The authors have no funding and conflicts of interest to disclose. 4, pp. You may be trying to access this site from a secured browser on the server. eCollection 2020. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. Five months postoperatively, the patient reported no pain (0/10) and possessed 95% of his normal function at this time. Federal government websites often end in .gov or .mil. 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. He had an active range of motion from 0 to 130 degrees of flexion, and there was no lag with straight leg raise. He was also encouraged to become full weight-bearing with the brace until its removal two months postoperatively. 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. 2004 Mar-Apr;24(2):181-4. doi: 10.1097/00004694-200403000-00009. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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). A literature search was done to determine the expected clinical outcome of this fracture pattern. Nonsurgical treatments may cause fracture malunion, anterior knee pain, and even patellar dislocation. complications are occasional and functional recuperation is common after closed reduction and cast immobilization for slightly or no displaced fractures, otherwise open reduction and internal fixation for displaced fractures. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. 692696, 2012. The authors report 7 cases of acute tibial tubercle avulsion fractures. less common pattern of temporal bone fracture (10-30%) the fracture line is perpendicular to the long axis of the petrous 2004. 118121, 2010. Following the injury, he was evaluated in an outside emergency department, where anterior, posterior, and lateral radiographs obtained in the emergency department demonstrated a tibial fracture consisting of two primary components (Figure 1). Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Data is temporarily unavailable. E31E34, 2016. 5, pp. doi: 10.23750/abm.v92iS3.12580. 2004 Jul;12(4):271-6. doi: 10.1007/s00167-003-0417-0. This case report is limited in the duration of follow-up. 2, no. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. 2021 Feb 10;13(2):e13256. PMC Longitudinal vs transverse petrous temporal bone fracture. For a complete overview of all the cookies used, please see our privacy policy. An avulsion fracture to your foot or ankle may require a cast or walking boot. At this time, it was recommended that the patient begin gentle active range of motion exercises with extension and light flexion. In this case, suture anchors were placed along the anatomic insertion of the patellar tendon on the anterior tibial cortex. As soon as pain begins to improve, these medications can be stopped. Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. Methods: Records of 12 patients aged 11 to 17 (mean, 14) Result: On the 4th day following fixation the open fracture wound broke down, but the bacteria culture was negative. Copyright 2022 Elsevier B.V. or its licensors or contributors. 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. However, there were no such reports of patients suffering multiple injuries in addition to a tubercle avulsion fracture. The site is secure. The site is secure. 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]. An official website of the United States government. Osgood-Schlatter Disease as a Possible Cause of Tibial Tuberosity Avulsion. 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. Ten patients had excellent results and 2 had fair results. Fractures usually take about three to 12 weeks to heal completely. M. T. Stepanovich and J. 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. No neurovascular deficit was noted. The https:// ensures that you are connecting to the 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? government site. Disclaimer, National Library of Medicine Part B, vol. Epub 2020 May 8. 561566, 2012. Rev Chir Orthop Reparatrice Appar Mot. Georgiou G, Dimitrakopoulou A, Siapkara A, Kazakos K, Provelengios S, Dounis E. Knee Surg Sports Traumatol Arthrosc. 39, no. 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. Proximal tibial fractures: current treatment, results, and problems. Arkader A, Schur M, Refakis C, Capraro A, Woon R, Choi P. J Pediatr Orthop. A torn patellar tendon was noted in one adolescent having a stage IIIB avulsion fracture. 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]. 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. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. Previous reports of tibial tubercle avulsion fractures noted patients who had concomitant tendon avulsion, meniscal damage, ligament injury, and vascular compromise. Most injuries in adolescent occur during school sports like volleyball, football or basketball. 35, no. 19, no. HHS Vulnerability Disclosure, Help Epub 2006 Aug 18. Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. 2020 Mar 16;2020:8650927. doi: 10.1155/2020/8650927. Upon presentation to the clinic the following day, he reported mild pain (3/10) and noted no normal function of his leg. In 4 cases, the fracture was displaced and necessitated an internal fixation with plaster for about 6 weeks. The patient was seen 1 week postoperatively and noted moderate pain (6/10) and 0% normal function. X-rays will be taken after surgery to assess the position of the implants & the realignment of the bone. MeSH 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. By continuing you agree to the use of cookies. Acute tibial tubercle avulsion fractures. By continuing to use this website you are giving consent to cookies being used. Purpose: To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. China (e-mail: [emailprotected]). The main factors of bone healing were as follows, first, the blood supply of proximal of tibia was better than the distal. 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. (The Ethics Committee of Tengzhou Central People's Hospital approved the study. We review the pathophysiology, mechanism, classification, diagnosis, and management of this injury. Drs Jakoi, Freidl, Old, Javandel, Tom, and Realyvasquez have no relevant financial relationships to disclose. The remaining 9 fractures were treated with open reduction and internal fixation. The distal patellar tendon was completely avulsed through two-thirds of its length. PMC 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 Bauer T, Milet A, Odent T, Padovani JP, Glorion C. Rev Chir Orthop Reparatrice Appar Mot. 2003 Jul;34(3):397-403. doi: 10.1016/s0030-5898(02)00061-5. 2007. 4. Orthop Clin North Am. 6, pp. Also read: Tibial plateau There was no laxity with varus or valgus stress. Clipboard, Search History, and several other advanced features are temporarily unavailable. This site needs JavaScript to work properly. 8600 Rockville Pike 6, pp. 5. eCollection 2020 May. Cureus. Epub 2005 Oct 24. 4, pp. 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]. We describe a case in an adult who suffered a left knee injury due to a fall from height. He was unable to stand and was sent to the emergency department after the wound was dressed. FOIA Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. may email you for journal alerts and information, but is committed Distally, the course of the superficial perineal nerve was identified and the nerve itself was protected during the distal release of the anterior compartment. 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. Radiographic imaging revealed well-positioned screws, no evidence of new fractures or foreign bodies, and early evidence of callus formation. Some features may aid in distinguishing them. Roentgenographic examination revealed a tibial tuberosity avulsion fractures similar to a Type I (Watson-Jones)12 with internal rotation displacement of the fracture fragment combined with a proximal tibial and fibula fracture (Figure 1). 27, no. Would you like email updates of new search results? 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. Long-term outcome was excellent in all patients regardless of fracture type. Old, M. Javandel, J. Tom, and J. Realyvasquez, Tibial tubercle avulsion fractures in adolescent basketball players, Orthopedics, vol. 3, pp. Before World J Pediatr Surg. 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. 8600 Rockville Pike Avulsion fracture of the tibial tuberosity in late adolescence. 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 Postoperative anteroposterior and lateral film radiographs in 2 days after operation. eCollection 2020. The work cannot be changed in any way or used commercially. 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. Consequently an anatomical reduction and stable fixation is required to assure it heals anatomically. eCollection 2020. 2022 Mar 10;92(S3):e2021571. Your doctor will often prescribe medications for pain-relief for a short period of time after the injury or surgery. 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. 32, no. doi: 10.1136/wjps-2020-000169. Results: This website uses cookies. 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. No complications were noted. The tibial tubercle is the bony attachment on the large bone of the lower leg (tibia) of the big, powerful thigh muscle (quadriceps). 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. 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. Seven patients (low-stress group) had a spontaneous X-ray is the key to diagnosis. D. O. Clarke, S. A. Franklin, and D. E. Wright, Avulsion fracture of the tibial tubercle associated with patellar tendon avulsion, Orthopedics, vol. 2, pp. Transverse petrous temporal bone fracture. 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