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Risk factor analysis for tibial tubercle avulsion fractures in children

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Abstract

Purpose

Tibial tubercle avulsion fractures (TTAFs) are rare in children, particularly bilateral TTAFs. This study aimed to elucidate the associating factors of TTAF, and compare the risk factor profiles of unilateral and bilateral injuries, thus provide clinical theoretical basis for reducing the occurrence of TTAFs.

Methods

TTAF paediatric patients who were hospitalized between April 2017 and November 2022 were retrospectively analysed. Children who presented for physical examination during the same period were randomly selected, and were age- and sex-matched as controls. A subgroup analysis based on endocrine function was also performed. A risk factor analysis for bilateral TTAF was performed as well. Data were collected via medical records and a questionnaire. All variables were assessed for association with TTAF using univariate and multiple logistic regression analyses.

Results

A total of 64 TTAF patients and controls were respectively included. Multivariate analysis demonstrated BMI (P = 0.000，OR = 3.172), glucose (P = 0.016，OR = 20.878), and calcium (P = 0.034，OR = 0.000) as independent associating factors of TTAF. Subgroup analysis showed significant differences in oestradiol (P = 0.014), progesterone (P = 0.006) and insulin levels (P = 0.005) between the TTAF and control groups. Bilateral TTAF was found to significantly associate with a history of knee joint pain (P = 0.026).

Conclusion

High BMI, hyperglycaemia, and low calcium levels were found as independent risk factors for TTAF in children. In addition, decreased oestradiol, elevated progesterone, and insulin resistance were identified as potential risk factors for TTAF. A history of knee pain may be suggestive of bilateral TTAF.

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Data availability

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

The codes are available from the corresponding author on reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Yiwei Wang and Peng Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics surgery, Children’s Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China

    Yiwei Wang, Minjie Fan, Hanjie Zhuang, Ruoyi Guo, Pengfei Zheng & Kai Tang

  2. Department of Orthopaedics Surgery, National Children’s Medical Center, Children’s Hospital of Fudan University, Wanyuan Road 399, Minhang District, Shanghai, China

    Peng Huang

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yiwei Wang and Minjie Fan. The first draft of the manuscript was written by Yiwei Wang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Pengfei Zheng or Kai Tang.

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The authors have no relevant financial or non-financial interests to disclose.

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The study was approved by the ethics committee of the Children's Hospital of Nanjing Medical University (202210179-1).

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Wang, Y., Huang, P., Fan, M. et al. Risk factor analysis for tibial tubercle avulsion fractures in children. International Orthopaedics (SICOT) 47, 2347–2356 (2023). https://doi.org/10.1007/s00264-023-05889-5

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