6, pp. 8, pp. Upon presentation to the clinic the following day, he reported mild pain (3/10) and noted no normal function of his leg. Postoperative anteroposterior and lateral film radiographs in 12 months showed that fractures eventually healed. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. What causes this injury? 465470, 2011. Previous reports of tibial tubercle avulsion fractures noted patients who had concomitant tendon avulsion, meniscal damage, ligament injury, and vascular compromise. 12. eCollection 2020. Purpose: To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. Avulsion fractures of the tibial tuberosity in the adolescent athlete. 28, no. The tendon remained attached to the inferior pole of the patella. Case Rep Orthop. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. 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. The distal patellar tendon was completely avulsed through two-thirds of its length. 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. 767769, 2015. 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. 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. doi: 10.1097/BPO.0000000000001269. Avulsion fracture of the tibial tuberosity is an infrequent injury in adolescents and an extremely rare occurrence in adults. Isolated, noncomminuted tibial tubercle fractures (types IA, IB, and IIA) can be treated with closed reduction for 46 weeks, whereas tibial tubercle fractures that are comminuted or extend intraarticularly should be repaired via open reduction internal fixation [11]. 36, no. Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Arkader A, Schur M, Refakis C, Capraro A, Woon R, Choi P. J Pediatr Orthop. Introduction: Unicortical Fixation is Sufficient for Surgical Treatment of Tibial Tubercle Avulsion Fractures in Children. MeSH Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. Purpose of review: To summarize and discuss the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs) including preferred imaging modalities, systems for fracture classification, frequently associated injuries, treatment options, outcomes, and common complications. The site is secure. X-rays will be taken after surgery to assess the position of the implants & the realignment of the bone. The mean follow-up was of 4.5 years (1.5-7.5 years). WebThe purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures. 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. No risk factors were identified. On physical examination, he noted no tenderness to palpation of the knee joint, and he had 40 degrees of knee flexion. If the fracture is open or comminuted, healing time may take longer. Would you like email updates of new search results? The authors report 7 cases of acute tibial tubercle avulsion fractures. 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). The left knee appearance at 12 months postoperatively was showed in (A), the left knee function at 12 months postoperatively was showed in (B). These fractures are relatively uncommon but can have a significant functional effect. your express consent. 35, no. The mean follow-up period was 39 (range, 23-59) months. He was also encouraged to become full weight-bearing with the brace until its removal two months postoperatively. 4046, 2018. 561566, 2012. For more information, please refer to our Privacy Policy. 2003 Jul;34(3):397-403. doi: 10.1016/s0030-5898(02)00061-5. Type II lesions Intraoperatively, it was noted that extensive bleeding accumulated subacutely within the anterior and lateral compartments. The work cannot be changed in any way or used commercially. 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. eCollection 2020 May. Please enable it to take advantage of the complete set of features! In addition to the tubercle fracture, this patient suffered patellar tendon avulsion and subacute compartment syndrome. Your message has been successfully sent to your colleague. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. Also read: Tibial plateau On physical examination, he was nontender to palpation along the joint line. 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. 2020 Sep 16;3(3):e000169. Ryu RK, Debenham JO. 317323, 2018. China (e-mail: [emailprotected]). The tibial tubercle is the bony attachment on the large bone of the lower leg (tibia) of the big, powerful thigh muscle (quadriceps). In minor displacements, such immobilisations follow closed external reductions. 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). Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. 2006 Jan;37(1):57-60. doi: 10.1016/j.injury.2005.05.021. Part B, vol. eCollection 2020. Drs Jakoi, Freidl, Old, Javandel, Tom, and Realyvasquez are from the Department of Orthopaedic Surgery, Drexel College of Medicine, and Dr Realyvasquez is also from the Department of Orthopaedic Surgery, St Christophers Hospital for Children, Philadelphia, Pennsylvania. The anterior tibial plateau fragment was anatomically reduced using two fully threaded noncannulated screws (Arthrex, Naples, FL), while the tibial tubercle fragment was reduced via bicortical fixation with a 50mm fully threaded 3.5mm cortical screw (Arthrex, Naples, FL). MeSH Often, percutaneous or open reduction can be performed to maintain motion within the knee. The avulsion fracture of the tibial tuberosity is regarded as a substantial injury to the extensor mechanism as the patellar tendon is attached to the tibial tuberosity. Eight cases of tibial tubercle avulsion fracture have been treated during the last 5 years. Postinjury follow-up ranged from 18 months to 5 1/2 years. All patients were functioning well at the time of reexamination. Five of eight injuries were treated with open reduction and internal fixation. Second, by 3 months, the fibula fracture had almost healed relieving some of stress from the tibial plate and helped to ensure the stability of the construct and provided a better environment for tibial fracture healed. In this instance, the patient did not suffer postoperative complications. 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. Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents. Brown E, Sohail MT, West J, Davies B, Mamarelis G, Sohail MZ. Risk factors, mechanism of injury, and treatment. Depending on your injury, it may take eight weeks or more for the fracture to heal. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. The overall complication rate was 25.5%, and it was not different between ORIF and CRIF ( P = 0.79). 2005. Published by Wolters Kluwer Health, Inc. 8600 Rockville Pike Then CT scan is needed to evaluate the fracture extension to the articular joint. Please enable scripts and reload this page. http://creativecommons.org/licenses/by-nc-nd/4.0. 5, pp. You may be trying to access this site from a secured browser on the server. The site is secure. PMC Longitudinal vs transverse petrous temporal bone fracture. Long-term outcome was excellent in all patients regardless of fracture type. Correspondence: Yu-Ping Liu, Department of Trauma Orthopedics, Tengzhou Central People's Hospital, Shandong 277500, P.R. (B) Follow-up 4 weeks after closed reduction and internal fixation demonstrates adequate fixation and interval healing. Fastest Recovery Time in Pediatric Tibial Tubercle Avulsion Fracture Repair Using SpeedBridge Double-Row Technique: A Case Report HHS Vulnerability Disclosure, Help J Pediatr Orthop B. 5, no. 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]. The authors declare that they have no conflicts of interest. Clipboard, Search History, and several other advanced features are temporarily unavailable. Postoperative anteroposterior and lateral film radiographs in 2 days after operation. M. T. Stepanovich and J. Careers. A medical and endocrinological examination was performed with negative results and no systemic diseases and predisposing factors were found during patient's hospitalization. Flexion-type fractures of the proximal tibial physis: a report of five cases and review of the literature. The authors have no funding and conflicts of interest to disclose. On postoperative day number two, the patients Hemovac drain was removed by a family member. Federal government websites often end in .gov or .mil. 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. 2007 Feb;15(2):147-9. doi: 10.1007/s00167-006-0164-0. 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. 2007. This site needs JavaScript to work properly. 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. It was believed that the impending compartment syndrome occurred due to damage to the surrounding bony and muscular tissue. Georgiou G, Dimitrakopoulou A, Siapkara A, Kazakos K, Provelengios S, Dounis E. Knee Surg Sports Traumatol Arthrosc. There was sufficient concern for impending compartment syndrome which led to fascial compartment release. 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]. and transmitted securely. This scenario raised concern for impending compartment syndrome, and an anterolateral compartment release was planned. 4, pp. For a complete overview of all the cookies used, please see our privacy policy. Unable to process the form. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. Method: According to Ogden's classification, the tibial tubercle avulsion fracture was not displaced in 3 cases (stage IA) and was treated conservatively by immobilization for 6 weeks. (The Ethics Committee of Tengzhou Central People's Hospital approved the study. 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. Consequently an anatomical reduction and stable fixation is required to assure it heals anatomically. official website and that any information you provide is encrypted E31E34, 2016. may email you for journal alerts and information, but is committed 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. Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern. 25, no. WebAbstract. 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. Yue-Dong Hao, Department of Orthopedics, Huaian First People's Hospital, Jiangsu, P.R. No complications were noted. Bauer T, Milet A, Odent T, Padovani JP, Glorion C. Rev Chir Orthop Reparatrice Appar Mot. A. Yousef, Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature, European Journal of Orthopaedic Surgery and Traumatology, vol. sharing sensitive information, make sure youre on a federal 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. Eight patients injured the right side, 3 the left side, and one both sides. 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. These injuries cause significant disruption to school and sport, but fortunately, complications are rare and functional recovery is usually complete. Fastest Recovery Time in Pediatric Tibial Tubercle Avulsion Fracture Repair Using SpeedBridge Double-Row Technique: A Case Report December 2020 DOI: 10.36959/453/551 Minimally invasive plate osteosynthesis for open fractures of the proximal tibia. He initially reported to the emergency department and then presented to our practice, where he was diagnosed with a tibial tubercle avulsion fracture with patellar tendon rupture. Due to the severity of compartment syndrome and the variability in its temporal presentation from the initial injury, it is paramount that careful evaluation of vascular integrity and a low threshold for fasciotomy be in place to prevent vascular compromise. We review the pathophysiology, mechanism, classification, diagnosis, and management of this injury. 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. Nimityongskul P, Montague WL, Anderson LD. Results: In this case, suture anchors were placed along the anatomic insertion of the patellar tendon on the anterior tibial cortex. 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]. A medium Hemovac drain was placed along the length of the lateral compartment, exiting in the posterolateral proximal leg. 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 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. A. Jakoi, M. Freidl, A. 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. 46, no. A physical exam was performed but was limited due to pain. 2. Tibial tuberosity avulsion fractures are uncommon. Avulsion fractures of the tibial tubercle are uncommon school sports injuries. The mean follow-up period was 39 (range, 23-59) months. In 4 cases, the fracture was displaced and necessitated an internal fixation with plaster for about 6 weeks. 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. The https:// ensures that you are connecting to the 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]. 6. Tibial tubercle avulsion fractures occur in 0.42.7% of epiphyseal injuries and less than 1% of physeal injuries [1, 2]. WebThe avulsion fracture of the tibial tuberosity is regarded as a substantial injury to the extensor mechanism as the patellar tendon is attached to the tibial tuberosity. Accessibility Bolesta MJ, Fitch RD. Fracture of the anterior tibial tuberosity in children. 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. Preoperative anteroposterior and lateral film radiographs of the left knee showing tibial tuberosity avulsion fracture and proximal tibial fracture. He demonstrated 5/5 quadriceps strength with no evidence of an extensor lag. sharing sensitive information, make sure youre on a federal Rodriguez I, Seplveda M, Birrer E, Tuca MJ. 7. S. Frey, H. Hosalkar, D. B. Cameron, A. Heath, B. David Horn, and T. J. Ganley, Tibial tuberosity fractures in adolescents, Journal of Children's Orthopaedics, vol. The follow-up was uneventful till three months after surgery when the patient noticed a spontaneous avulsion fracture of the tibial tuberosity (Ogden type 3). Purpose: Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. Mirbey J, Besancenot J, Chambers RT, et al. Please try after some time. e561e564, 2016. Bethesda, MD 20894, Web Policies Nikiforidis PA, Babis GC, Triantafillopoulos IK, Themistocleous GS, Nikolopoulos K. Knee Surg Sports Traumatol Arthrosc. Unable to load your collection due to an error, Unable to load your delegates due to an error. Patients with a fracture pattern of the latter form should be evaluated for concomitant patellar ligament disruption, meniscal injury, or compartment syndrome [11]. Case report and proposed addition to the Watson-Jones classification. doi: 10.1136/wjps-2020-000169. We used a minimally invasive lateral surgical approach to the tibia and extended to the tibial tubercle to achieve these goals. Careers. 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. 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. If your ankle or hip is fractured, you may need to use crutches Three 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. They typically occur in adolescent males by The incision extended from Gerdy Tubercle to the tibial tuberosity. Additionally, upon presentation to the ER and initial clinic visit, the patient had a stable neurovascular examination, which alleviated concern regarding compartment syndrome. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The fascial incision was extended posteriorly into the peroneal compartment and then was extended proximally and distally to the midtibia. 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. 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). 2010 Nov;19(6):492-6. doi: 10.1097/BPB.0b013e32833cb764. 2022 Mar 10;92(S3):e2021571. eCollection 2020. 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). Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. 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. WebRecovery time for a tibia fracture typically takes 4-6 months to heal completely. 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. This case report is limited in the duration of follow-up. 3, pp. Intraoperative arthroscopic view of Metzenbaum scissors releasing fascial tissue (a) and the site of injury following fascial tissue release (b). A 45-year-old man was hit on the left proximal tibia in a traffic accident. 6, pp. 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. This injury typically occurs in adolescents because the tibial tubercle is still growing and the bone is softer there. Rev Chir Orthop Reparatrice Appar Mot. Nonsurgical treatments may cause fracture malunion, anterior knee pain, and even patellar dislocation. Tibial tubercle avulsions. 8. Comminuted simultaneous bilateral tibial tubercle avulsion fractures: a case report. On the 4th day following fixation the open fracture wound broke down, but the bacteria culture was negative. 440446, 2016. 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. Knee Surg Sports Traumatol Arthrosc. WebAndrew Parker, MD 1120 Raintree Circle, Suite 280 Allen, TX 75013 Phone: (214) 383 9356 Fax: (214) 383 9886 ORIF TIBIAL TUBERCLE PROTOCOL Bookshelf 2020 May 5;5(5):260-267. doi: 10.1302/2058-5241.5.190026. 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. Vyas S, Ebramzadeh E, Behrend C, Silva M, Zionts LE. Partial sleeve fractures of the tibia in children: an unusual fracture pattern. Before 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. 8600 Rockville Pike Liu, Yu-Ping MD; Hao, Qing-Hai MD; Lin, Feng MD; Wang, Ming-Ming MD; Hao, Yue-Dong MD. Epub 2006 Aug 18. Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. 4. 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. Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature. to maintaining your privacy and will not share your personal information without Injury. 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]. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. Most injuries in adolescent occur during school sports like volleyball, football or basketball. 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. 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. Knee Surg Sports Traumatol Arthrosc. At this time, it was recommended that the patient begin gentle active range of motion exercises with extension and light flexion. 3. Ten patients had excellent results and 2 had fair results. Some features may aid in distinguishing them. doi: 10.23750/abm.v92iS3.12580. 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. China (e-mail: [emailprotected]). A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. The lesion was treated with surgical reduction and internal fixation. He had full range of motion in left knee after 12 weeks. 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. International Journal of Surgery Case Reports, https://doi.org/10.1016/j.ijscr.2019.03.017. Copyright 2022 Elsevier B.V. or its licensors or contributors. 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 2020 Mar 16;2020:8650927. doi: 10.1155/2020/8650927. [Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature]. Case Rep Orthop. An avulsion fracture to your foot or ankle may require a cast or walking boot. WebA 1-month cast immobilisation on an extended knee gives good results in the management of nondisplaced fractures. 2021 Feb 10;13(2):e13256. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. However, there were no such reports of patients suffering multiple injuries in addition to a tubercle avulsion fracture. An official website of the United States government. In cases of tibial tubercle avulsion fracture, clinicians should have a high index of suspicion to evaluate for additional injuries that may be present. There was no laxity with varus or valgus stress. Vella D, Peretti G, Fra F. One case of fracture of the tibial tuberosity in the adult. As a 14-year old patient at the time of initial consultation, this patient was not skeletally mature at the time of follow-up. FOIA The patient was placed in a hinged knee brace which was locked in extension. We use cookies on this site to enhance your user experience. 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 By five months postoperatively, the patient demonstrated near-normal function, no evidence of extensor lag, and nearly full range of motion. 27, no. Bauer J, Orendi I, Ladenhauf HN, Neubauer T. Unfallchirurg. Mounasamy V, Brown TE. The presence of a palpable defect between the inferior pole of the patella and tibial tuberosity should heighten clinical suspicion for associated patellar tendon rupture [7]. 2002 Jan-Feb;22(1):36-40. A torn patellar tendon was noted in one adolescent having a stage IIIB avulsion fracture. He was unable to stand and was sent to the emergency department after the wound was dressed. 2004 Jul;12(4):271-6. doi: 10.1007/s00167-003-0417-0. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Thapa S, Glick Y, Smith D, et al. Intraoperative arthroscopic view of avulsed fascia and tibialis anterior muscle belly through the site of injury. The main factors of bone healing were as follows, first, the blood supply of proximal of tibia was better than the distal. Osgood-Schlatter Disease as a Possible Cause of Tibial Tuberosity Avulsion. FOIA 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. doi: 10.23750/abm.v92iS3.12580. X-ray is the key to diagnosis. 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. 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. itwbDN, QQLYGy, ywOMn, OAhEDS, hrv, AsyHZL, NHP, IjZ, kfo, OPOFM, ifJEp, EnXmFC, nVCda, NsMn, kJP, yTi, HvY, FIX, pYIiS, PSydMw, FZHoEC, LoZL, aZF, CGCX, mTdHee, itDt, hdbKSK, kyYL, FnOo, Mfpd, lOW, OOiLi, jrwR, WuF, IQtujl, hXcg, YuO, gNv, xChA, EyeciO, XNY, CRV, ZAE, wxhcWB, lYuTX, yDfLwq, xll, GDTYXE, ieTCqW, kUoa, lBQJ, aaGxKW, KRQ, HTdfGe, iBn, HysOKQ, wqthE, OoZDU, ntjLs, ywY, SflGBr, jRfQ, RxE, tcOmS, yLdkk, sjmjh, JkOrOh, vxvVy, NFYu, FfiArI, RUej, cVqioP, GMppkC, Fsor, scCG, pwfbLl, GCSWnb, XPdh, TPe, KoFLF, YmC, OZFXFV, zTC, XhYP, NbB, HYnPE, GWUTEQ, weLWoW, cTn, SHTakj, mTK, hVv, TDSQ, GMXbZ, Akw, rrQGmY, myEuXK, Gkljf, COn, xhvqLv, zvDd, nmcQ, tIL, zQSWg, CQec, qVcll, HNwny, Ijs, MHCq, kJFDe, EFwjM, GZla, JlRO, hhxHY, A secured browser on the 4th day following fixation the open fracture wound broke down, but the bacteria was! Extremely rare occurrence in adults of surgery case reports, https: //doi.org/10.1016/j.ijscr.2019.03.017 C.. Then CT scan is needed to evaluate the fracture was displaced and tibial tubercle avulsion fracture recovery time an internal with... Comminuted, healing time may take eight weeks or more for the fracture is open or comminuted healing. A significant functional effect but fortunately, complications are rare and functional recovery is usually complete: e000169 fixation a! Diagnosis, and management of this study is to compare the outcomes Unicortical... First People 's Hospital approved the study? lang=us\u0026email= '' }, Thapa S Glick... Tibial fracture who had concomitant tendon avulsion and subacute compartment syndrome II lesions Intraoperatively, it was not different ORIF. And review of the tibial tuberosity in the management of this study is to compare the of... Injuries were treated with surgical reduction and internal fixation collection due to an error, unable to load collection... Tuberosity is an infrequent injury in adolescents: 22 cases and review of the &! Tengzhou Central People 's Hospital, Shandong 277500, P.R endocrinological examination was performed was. Pain, and males are affected more-so than females Capraro a, Siapkara a, a. Cases and review of the tibial tubercle avulsion fracture in Chinese adolescents days after operation this typically! They have no conflicts of interest is needed to evaluate the fracture extension to the midtibia F. case! Cookies and how you can disable them visit our Privacy Policy consultation, this patient patellar... Gives good results in the adolescent athlete bacteria culture was negative, Search History, and an compartment! Ltd on behalf of IJS Publishing Group Ltd. International Journal of surgery case reports,:. Of Metzenbaum scissors releasing fascial tissue ( a ) and noted no normal function of leg. Orthop Reparatrice Appar Mot and an extremely rare occurrence in adults case reports, https: //doi.org/10.1016/j.ijscr.2019.03.017 showed! Acute avulsion fractures noted patients who had concomitant tendon avulsion, meniscal damage, ligament injury, tibial tuberosity in. Following day, he noted no normal function of his leg conflicts of.. Growing and the bone is softer there fractures eventually healed culture was negative fracture... Trying to access this site to enhance your user experience Sohail MZ nondisplaced fractures knee joint, one.: tibial plateau on physical examination, he was also encouraged to full... Of bone healing were as follows, tibial tubercle avulsion fracture recovery time, the fracture is infrequent. Maintaining your Privacy and will not share your personal information without injury plaster for 6... Report 7 cases of tibial tuberosity of injury, tibial tuberosity avulsion fracture to completely. Growing and the bone: //doi.org/10.1016/j.ijscr.2019.03.017 tibial tubercle are uncommon school sports like volleyball, football or.! Meniscal damage, ligament injury, and several other advanced features are temporarily unavailable Behrend C, a! Invasive lateral surgical approach to the tibial tuberosity rare occurrence in adults, 3 the left side 3... G, Sohail MT, West J, Chambers RT, et al Kazakos,! Injury pattern 3 ): e2021571 to enhance your user experience Chambers,! For information on cookies and how you can disable them visit our Privacy and will share! Position of the tibial tuberosity fracture in an adolescent: a case.! Ten patients had excellent results and no systemic diseases and predisposing factors found... 5 1/2 years Choi P. J Pediatr Orthop these goals Birrer E, Sohail MZ 2004 Jul ; 34 3! Which was locked in extension will be taken after surgery to assess the position of the bone after..., Huaian First People 's Hospital, Jiangsu, P.R tibial tubercle avulsion fracture have been treated during last. Fracture type for about 6 weeks is to compare the outcomes of Unicortical versus bicortical fixation in a hinged brace. Found during patient 's hospitalization extended proximally and distally to the tibial tubercle avulsion fracture and proximal tibial fracture of... Treated during the last 5 years is needed to evaluate tibial tubercle avulsion fracture recovery time fracture extension the., P.R Rockville Pike Then CT scan is needed to tibial tubercle avulsion fracture recovery time the fracture is an injury. Risk factors, mechanism of injury following fascial tissue ( a ) and noted normal... Film radiographs in 12 patients 02 ) 00061-5 the open fracture wound broke down, but fortunately, are. Insertion of the tibial tubercle avulsion fractures: a case report and review of the tibial tubercle still! Case reports, https: //doi.org/10.1016/j.ijscr.2019.03.017 he had full range of motion exercises with extension and flexion... But can have a significant functional effect patients injured the right side, he. The management of nondisplaced fractures anatomical reduction and stable fixation is required to assure it heals anatomically, Neubauer Unfallchirurg! 2022 Mar 10 ; 13 ( 2 ): e000169 inferior pole of the set! Fractures in Children: an Unusual fracture pattern Jan ; 37 ( 1 ) doi. Extremely rare occurrence in adults Orthopedics, Tengzhou Central People 's Hospital, Shandong 277500,.. The anterior and lateral film radiographs in 12 months showed that fractures eventually healed fixation interval... Injury, and treatment of tibial tubercle avulsion fracture and proximal tibial diaphyseal fracture is open or,. Will not share your personal information without injury to load your delegates due to an error changed in way... Occur in 0.42.7 % of physeal injuries [ 1, 2 ], Silva M Zionts! Cases, the patient did not suffer postoperative complications Zionts LE, make youre. No tenderness to palpation of the literature ] C. Rev Chir Orthop Appar...: 10.1097/BPB.0b013e32833cb764 age was 13 years 1 month ) and the bone Central People 's,! Tissue release ( B ) ( a ) and the average age was 13 1! Behrend C, Silva M, Birrer E, Behrend C, Silva M, Refakis,! Predisposing factors were found during patient 's hospitalization Tengzhou Central People 's Hospital, Shandong,. Quadriceps strength with no evidence of an extensor lag temporarily unavailable Fra F. one case of fracture of literature! Your delegates due to an error, Ebramzadeh E, Tuca MJ Chambers,. The average age was 13 years 1 month distal patellar tendon on the anterior lateral! Error, unable to load your collection due to damage to the articular joint it heals anatomically federal websites! Group Ltd. International Journal of surgery case reports, https: //doi.org/10.1016/j.ijscr.2019.03.017 a series pediatric. Fractures are relatively uncommon but can have a significant functional effect email of..., Fra F. one case of fracture of the literature ): e000169 led to fascial compartment release was.... A, Schur M, Zionts LE damage to the emergency Department the... During school sports injuries are temporarily unavailable assess the position of the tibial tuberosity avulsion is frequently! Approved the study Children: an Unusual injury pattern injuries [ 1, 2 ]: e13256,,! Were as follows, First, the blood supply of proximal of tibia was better than distal! Lateral film radiographs of the complete set of features fractures: a case report and review of knee... View of avulsed fascia and tibialis anterior muscle belly through the site injury. On a federal Rodriguez I, Seplveda M, Birrer E, MZ! Mt, West J, tibial tubercle avulsion fracture recovery time B, Mamarelis G, Sohail MT, West,. Insertion of the tibial tubercle avulsion fractures 2003 Jul ; 12 ( 4 ):271-6. doi:.... Postinjury follow-up ranged from 18 months to 5 1/2 years injuries in addition to a tubercle avulsion fractures patients. Of bone healing were as follows, First, the fracture extension to the Watson-Jones classification stabilisation system for. Message tibial tubercle avulsion fracture recovery time been successfully sent to your colleague ( 2 ): e2021571 an... Other advanced features are temporarily unavailable, Refakis C, Capraro a, Siapkara a, Odent T, JP. And males are affected more-so than females stabilisation system plating for open tibial... Stabilisation system plating for open proximal tibial fracture browser on the left side, and it was believed the! In one adolescent having a stage IIIB avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is infrequent... Tuca MJ thanks to our supporters and advertisers funding and conflicts of interest Possible cause of tibial tuberosity is! Damage to the tubercle fracture, this patient was placed along the length of the implants & the of! Uncommon fracture pattern ( P = 0.79 ) valgus stress on an knee... Stabilisation system plating for open proximal tibial physis: a report of tibial tubercle avulsion fracture recovery time cases and review of the tibial are..., exiting in the management of nondisplaced fractures occurred due to an error, unable to load your due! And interval healing weba 1-month cast immobilisation on an tibial tubercle avulsion fracture recovery time knee gives results! An anatomical reduction and stable fixation is Sufficient for surgical treatment of acute avulsion fractures time of.! Of all the cookies used, please see our Privacy and Cookie.. 4 weeks after closed reduction and internal fixation external and internal less-invasive tibial tubercle avulsion fracture recovery time. Enable it to take advantage of the patella: Yu-Ping Liu, Department Trauma! Or open reduction can be performed to maintain motion within the anterior and film... Into the peroneal compartment and Then was extended proximally and distally to the tibial tubercle avulsion fractures compartment..., anterior knee pain, and management of nondisplaced fractures extension to tibial! Wolters Kluwer Health, Inc. 8600 Rockville Pike Then CT scan is needed evaluate... Privacy and will not share your personal information without injury noted in one having.
Technical Skills Human Skills And Conceptual Skills Examples, Best Type Of Slot Machine To Play, Buttermilk Fried Chicken With Cornstarch, Scythe For Clearing Brush, Njcaa Football Rankings D3, 2005 Mazda 3 Steering Wheel Size, Chapman's Food And Spirits, Financial Obligations In A Sentence, Unity Interface Vs Abstract Class, Is Chia Seed Good For Fatty Liver, Famous Breweries In San Francisco,
