Physeal Type Tibial Tuberosity Fracture in an Adolescent

Abstract

Fractures around the knee in the pediatric population are relatively rare. Specifically, tibial tuberosity fractures have an incidence ranging from 0.4% to 2.7% of all physeal injuries. Though uncommon, as participation in sports increases, as do the incidence of tibial tuberosity fractures. These injuries are common with activities that involve forceful quadriceps contraction during knee extension when jumping and/or aggressive passive flexion of the knee against the contracting quadriceps while landing. This mechanism, accompanied by the physiologic development of epiphysiodesis distally towards the tubercle in a posterior to anterior direction, makes active adolescents mechanically vulnerable to tibial tubercle fractures. Pandya et el. proposed four distinct fracture patterns based off physeal closure present at the time of injury. Physeal or Type B involves the tibial tubercle and the epiphysis, fracturing off the metaphysis as a unit, without any intra-articular involvement. This is typically result of an injury occurring when there has not been closure of the proximal tibial physis or tubercle. Anteroposterior and lateral radiographs are obtained during the time of injury, with focus to the lateral radiograph. Acutely, patients are managed surgically, involving a closed or open reduction with internal fixation. Emphasis is on a proper diagnosis, anatomic reduction, and a strong fixation to enhance short- and long-term outcomes while avoiding complications.