Tibial Tubercle Fracture: Teen Type

Abstract

Fractures of the tibial tubercle are a relatively infrequent fracture seen during adolescence, accounting for only 1% of all pediatric fractures (Mencio and Swiontkowski, Fractures around the knee in children. In: Green’s skeletal trauma in children, 5th edn. Elsevier Health Sciences, Philadelphia, pp 390–436, 2014). Such fractures are typically high energy in nature and can be associated with significant soft tissue stripping, occult intra-articular injury, vascular injury, and compartment syndrome. A type D/teen-type fracture, as recently classified by Pandya et al. (J Pediatr Orthop 32(8):749–759, 2012), describes an injury only to the distal tubercle as the proximal aspect of the physis has already closed. Surgical management of these injuries typically involves open reduction and internal fixation. Preoperatively, scrutiny of the lateral radiograph is essential to correctly classify the injury, and a low threshold for three-dimensional imaging is prudent. Key aspects to a successful operation are identification of associated injuries, removing interposed tissue from the fracture site, anatomic reduction, and solid internal fixation. Accurate diagnosis and management as well as strict adherence to surgical technique are critical to assuring a quality outcome and avoiding complications.