J Knee Surg 2023; 36(10): 1105-1108
DOI: 10.1055/s-0042-1750061
Original Article

Outcomes of Displaced Tibial Tubercle Fractures in Adolescents

Ally A. Yang
1   Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
,
Marcus Erdman
2   Department of Pediatrics, Wright-Patterson Air Force Base, Wright-Patterson AFB, Ohio
,
Ellius Kwok
1   Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
,
Gary Updegrove
3   Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
William L. Hennrikus
4   Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
› Author Affiliations
Funding None.

Abstract

Tibial tubercle fractures are uncommon injuries. The purpose of this study is to report the outcomes of surgical treatment of displaced tibial tubercle fractures in adolescents. This study was approved by the College of Medicine Institutional Review Board. A retrospective review was performed at our institution for patients who underwent surgical treatment of tibial tubercle fractures. Patient demographics, injury characteristics, and outcomes were recorded. A p-value of <0.05 was considered statistically significant. Nineteen male patients were identified. The average age was 14.6 years, and the average body mass index was 25.8. Basketball (63%) was the most common mechanism of injury. No patient was treated with bicortical screws. Two patients had preoperative computed tomography. One patient presented with acute compartment syndrome (ACS), and fasciotomy was performed. Twelve patients (63%) without clinical signs of ACS received anterior compartment fasciotomy on a case-by-case basis according to surgeon's preference. No growth injury, including growth arrest, angulation, or shortening occurred. All patients returned to preinjury activities at an average of 18.5 weeks. Displaced tibial tubercle fractures in this series occurred in male adolescents during athletic activity. Unicortical screws/pins were used with no loss of fixation. Routine use of advanced imaging was unnecessary. One patient (5%) underwent fasciotomy. No growth arrest occurred. All patients returned to preinjury athletic activities.



Publication History

Received: 24 August 2021

Accepted: 26 April 2022

Article published online:
07 July 2022

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  • References

  • 1 Ogden JA, Tross RB, Murphy MJ. Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am 1980; 62 (02) 205-215
  • 2 McKoy BE, Stanitski CL. Acute tibial tubercle avulsion fractures. Orthop Clin North Am 2003; 34 (03) 397-403
  • 3 Frey S, Hosalkar H, Cameron DB, Heath A, David Horn B, Ganley TJ. Tibial tuberosity fractures in adolescents. J Child Orthop 2008; 2 (06) 469-474
  • 4 Jakoi A, Freidl M, Old A, Javandel M, Tom J, Realyvasquez J. Tibial tubercle avulsion fractures in adolescent basketball players. Orthopedics 2012; 35 (08) 692-696
  • 5 Maffulli N, Grewal R. Avulsion of the tibial tuberosity: muscles too strong for a growth plate. Clin J Sport Med 1997; 7 (02) 129-132 , discussion 132–133
  • 6 Watson-Jones R. Fractures and Joint Injuries, vol. 2,. Baltimore, MA: Williams & Wilkins; 1970
  • 7 Levi JH, Coleman CR. Fracture of the tibial tubercle. Am J Sports Med 1976; 4 (06) 254-263
  • 8 Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop 2012; 32 (08) 749-759
  • 9 Brey JM, Conoley J, Canale ST. et al. Tibial tuberosity fractures in adolescents: is a posterior metaphyseal fracture component a predictor of complications?. J Pediatr Orthop 2012; 32 (06) 561-566
  • 10 Pretell-Mazzini J, Kelly DM, Sawyer JR. et al. Outcomes and complications of tibial tubercle fractures in pediatric patients: a systematic review of the literature. J Pediatr Orthop 2016; 36 (05) 440-446
  • 11 Kline AJ, Gonzales J, Beach WR, Miller MD. Vascular risk associated with bicortical tibial drilling during anteromedial tibial tubercle transfer. Am J Orthop 2006; 35 (01) 30-32
  • 12 Hernigou J, Chahidi E, Kashi M. et al. Risk of vascular injury when screw drilling for tibial tuberosity transfer. Int Orthop 2018; 42 (05) 1165-1174
  • 13 Haber DB, Tepolt FA, McClincy MP, Hussain ZB, Kalish LA, Kocher MS. Tibial tubercle fractures in children and adolescents: a large retrospective case series. J Pediatr Orthop B 2021; 30 (01) 13-18
  • 14 Pace JL, McCulloch PC, Momoh EO, Nasreddine AY, Kocher MS. Operatively treated type IV tibial tubercle apophyseal fractures. J Pediatr Orthop 2013; 33 (08) 791-796
  • 15 Arkader A, Schur M, Refakis C, Capraro A, Woon R, Choi P. Unicortical fixation is sufficient for surgical treatment of tibial tubercle avulsion fractures in children. J Pediatr Orthop 2019; 39 (01) e18-e22
  • 16 Formiconi F, D'Amato RD, Voto A, Panuccio E, Memeo A. Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update. Eur J Orthop Surg Traumatol 2020; 30 (05) 789-798
  • 17 Goodman TR, Mustafa A, Rowe E. Pediatric CT radiation exposure: where we were, and where we are now. Pediatr Radiol 2019; 49 (04) 469-478
  • 18 Pape JM, Goulet JA, Hensinger RN. Compartment syndrome complicating tibial tubercle avulsion. Clin Orthop Relat Res 1993; (295) 201-204
  • 19 Livingston KS, Glotzbecker MP, Shore BJ. Pediatric acute compartment syndrome. J Am Acad Orthop Surg 2017; 25 (05) 358-364
  • 20 Polakoff DR, Bucholz RW, Ogden JA. Tension band wiring of displaced tibial tuberosity fractures in adolescents. Clin Orthop Relat Res 1986; (209) 161-165
  • 21 Franz P, Luderowski E, Tuca M. Tibial tubercle avulsion fractures in children. Curr Opin Pediatr 2020; 32 (01) 86-92