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Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease

  • Technical Note
  • Published:
Journal of Children's Orthopaedics

Abstract

Background

Tibial tubercle fractures often occur in athletic adolescents close to skeletal maturity. These fractures can present with marked displacement of the apophysis, intra-articular extension, and associated soft tissue injuries, such as tibial meniscal ligament tears. Here, we present our surgical technique which focuses on recreating the meniscal–articular relationship (using suture anchors) in severely displaced fractures.

Methods

We retrospectively reviewed all tibial tuberosity fractures treated with this technique over the last 2.5 years. Fractures with a minimum of a 12-month follow-up post-fixation were identified. Clinical records and radiographs were reviewed. Data included patient age, gender, involved side, injury classification (modified Ogden), mechanism of injury, treatment, return to activity, and complications.

Results

Six patients met the inclusion criteria. Mean age at time of surgery was 14.9 (range 13.2–16.8) years. All patients were male and the mean follow-up period was 14 (12–26) months. Range of motion was started at 4 weeks post-operatively in a hinged knee brace, and return to sports occurred at an average of 3.75 months postoperatively (range 3–5 months). No evidence of growth disturbance of the proximal tibia or recurvatum at final follow-up was evident.

Conclusion

We speculate that patients who sustain a tibial tubercle avulsion fracture types III or V will likely have intra-articular pathology, specifically capsular avulsion or coronary ligament disruption. By utilizing suture anchors, our technique emphasizes renewing the anatomic articular environment to ensure better long-term results and maintaining these active individuals in sports.

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References

  1. Bolesta MJ, Fitch RD (1986) Tibial tubercle avulsions. J Pediatr Orthop 6(2):186–192

    Article  CAS  Google Scholar 

  2. Chow SP, Lam JJ, Leong JC (1990) Fracture of the tibial tubercle in the adolescent. J Bone Joint Surg Br 72(2):231–234

    CAS  Google Scholar 

  3. McKoy BE, Stanitski CL (2003) Acute tibial tubercle avulsion fractures. Orthop Clin North Am 34(3):397–403

    Article  Google Scholar 

  4. Mosier SM, Stanitski CL (2004) Acute tibial tubercle avulsion fractures. J Pediatr Orthop 24(2):181–184

    Article  Google Scholar 

  5. Frey S, Hosalkar H, Cameron DB, Heath A, David Horn B, Ganley TJ (2008) Tibial tuberosity fractures in adolescents. J Child Orthop 2(6):469–474

    Article  Google Scholar 

  6. Hand WL, Hand CR, Dunn AW (1971) Avulsion fractures of the tibial tubercle. J Bone Joint Surg Am 53(8):1579–1583

    CAS  Google Scholar 

  7. Pesl T, Havranek P (2008) Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method. J Child Orthop 2(5):353–356

    Article  Google Scholar 

  8. Watson-Jones R (ed) (1955) Fractures and joint injuries, vol 2, 4th edn. Williams & Wilkins, Baltimore

    Google Scholar 

  9. Bauer T, Milet A, Odent T, Padovani JP, Glorion C (2005) Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature. Rev Chir Orthop Reparatrice Appar Mot 91(8):758–767

    Article  CAS  Google Scholar 

  10. Choi NH, Kim NM (1999) Tibial tuberosity avulsion fracture combined with meniscal tear. Arthroscopy 15(7):766–769

    Article  CAS  Google Scholar 

  11. Falster O, Hasselbalch H (1992) Avulsion fracture of the tibial tuberosity with combined ligament and meniscal tear. Am J Sports Med 20(1):82–83

    Article  CAS  Google Scholar 

  12. Ogden JA, Tross RB, Murphy MJ (1980) Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am 62(2):205–215

    CAS  Google Scholar 

  13. Wiss DA, Schilz JL, Zionts L (1991) Type III fractures of the tibial tubercle in adolescents. J Orthop Trauma 5(4):475–479

    Article  CAS  Google Scholar 

  14. Yacoubian SV, Nevins RT, Sallis JG, Potter HG, Lorich DG (2002) Impact of MRI on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 16(9):632–637

    Article  Google Scholar 

  15. Zrig M, Annabi H, Ammari T, Trabelsi M, Mbarek M, Ben Hassine H (2008) Acute tibial tubercle avulsion fractures in the sporting adolescent. Arch Orthop Trauma Surg 128(12):1437–1442

    Article  Google Scholar 

  16. Ogden JA, Hempton RJ, Southwick WO (1975) Development of the tibial tuberosity. Anat Rec 182(4):431–445

    Article  CAS  Google Scholar 

  17. Mirbey J, Besancenot J, Chambers RT, Durey A, Vichard P (1988) Avulsion fractures of the tibial tuberosity in the adolescent athlete. Risk factors, mechanism of injury, and treatment. Am J Sports Med 16(4):336–340

    Article  CAS  Google Scholar 

  18. Ehrenborg G, Engfeldt B (1961) The insertion of the ligamentum patellae on the tibial tuberosity. Some views in connection with the Osgood-Schlatter lesion. Acta Chir Scand 121:491–499

    CAS  Google Scholar 

  19. Frankl U, Wasilewski SA, Healy WL (1990) Avulsion fracture of the tibial tubercle with avulsion of the patellar ligament. Report of two cases. J Bone Joint Surg Am 72(9):1411–1413

    CAS  Google Scholar 

  20. Ryu JO, Debenham RK (1985) An unusual avulsion fracture of the proximal tibial epiphysis. Case report and proposed addition to the Watson-Jones classification. Clin Orthop Relat Res 194:181–184

    Google Scholar 

  21. Polakoff RW, Bucholz DR, Ogden JA (1986) Tension band wiring of displaced tibial tuberosity fractures in adolescents. Clin Orthop Relat Res 209:161–165

    Google Scholar 

  22. Fletcher IR, Healy TE (1983) The arterial tourniquet. Ann R Coll Surg Engl 65(6):409–417

    CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. San Antonio Military Medical Center, Brooke Army Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, TX, 78234-6200, USA

    William R. Howarth

  2. Department of Pediatric Orthopaedic Surgery, Rady Children’s Hospital San Diego, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Hilton P. Gottschalk & Harish S. Hosalkar

Authors
  1. William R. Howarth
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  2. Hilton P. Gottschalk
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  3. Harish S. Hosalkar
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Corresponding author

Correspondence to Harish S. Hosalkar.

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Howarth, W.R., Gottschalk, H.P. & Hosalkar, H.S. Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease. J Child Orthop 5, 465–470 (2011). https://doi.org/10.1007/s11832-011-0369-8

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  • DOI: https://doi.org/10.1007/s11832-011-0369-8

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