Management of pediatric tibial tubercle fractures: Is surgical treatment really necessary?

  • P. Checa BetegónEmail author
  • C. Arvinius
  • M. I. Cabadas González
  • A. Martínez García
  • R. Del Pozo Martín
  • F. Marco Martínez
Original Article • KNEE - PAEDIATRIC


Fractures of the anterior tibial tubercle are infrequent lesions. They often occur in male adolescent athletes, usually in relation with sports involving powerful jumps. We present a retrospective study of 10 patients, with an average age of 15.1 years, all of them males, and a total of 11 acute avulsions of the anterior tibial tubercle. We analyzed the etiology of the lesion, the type of treatment used as well as non-weight bearing period, protected immobilization period, and time until sports reincorporation. We obtained 11 acute avulsions: one case of type I; three cases of type II; four cases of type III; and three cases of type IV. Five cases were treated conservatively, including the three cases of type IV, and surgery was only performed in six cases since an anatomical reduction was not obtained with closed reduction. The results were satisfactory in all cases, with 100% percentage of sport reincorporation in less de 25 weeks. We registered only one complication, intolerance of material, which did not require additional surgeries. These fractures, although rare, have an excellent prognosis. Even if they are often treated surgically, we have obtained good results with the conservative treatment in patterns previously reported as surgical.


Anterior tibial tubercle avulsion Anterior tibial tubercle fracture ATT fracture Proximal tibia fractures Pediatric fractures of the tibia 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Schiller J, DeFroda S, Blood T (2017) Lower extremity avulsion fractures in the pediatric and adolescent athlete. J Am Acad Orthop Surg 25(4):251–259CrossRefGoogle Scholar
  2. 2.
    Howarth WR, Gottschalk HP, Hosalkar HS (2011) Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease. J Child Orthop 5(6):465–470CrossRefGoogle Scholar
  3. 3.
    Mubarak SJ, Kim JR, Edmonds EW, Pring ME, Bastrom TP (2009) Classification of proximal tibial fractures in children. J Child Orthop 3(3):191–197. CrossRefGoogle Scholar
  4. 4.
    Khoriati AA, Guo S, Thakrar R, Deol RS, Shah KY (2015) Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature. Injury 46(4):767–769CrossRefGoogle Scholar
  5. 5.
    Pape JM, Goulet JA, Hensinger RN (1993) Compartment syndrome complicating tibial tubercle avulsion. Clin Orthop Relat Res 295:201–204Google Scholar
  6. 6.
    Mata SG (1991) Fractura-avulsión de la tuberosidad tibial anterior en adolescentes. A propósito de dos casos. Revisión de la literatura. Rev Esp de Cir Ost 4:211–217Google Scholar
  7. 7.
    Medvecky M, Noonan B (2009) Fractures about the knee in children and adolescents. Tech Orthop 24(3):204–210CrossRefGoogle Scholar
  8. 8.
    Subbu R, Nandra R, Jordan R, Krikler S (2013) Lessons learnt from managing an avulsion fracture of the tibial tubercle extending into the tibial physis. BMJ Case Rep 2031:bcr2013200551. CrossRefGoogle Scholar
  9. 9.
    Pretell-Mazzini J, Kelly DM, Sawyer JR, Esteban EMA, Spence DD, Warner WC, Beaty JH (2016) Outcomes and complications of tibial tubercle fractures in pediatric patients: a systematic review of the literature. J Pediatr Orthop 36(5):440–446CrossRefGoogle Scholar
  10. 10.
    Narayana Gowda BS, Mohan Kumar J (1903) Simultaneous bilateral tibial tubercle avulsion fracture in a case of pre-existing osgood-schlatter disease (OSD). J Orthop Case Rep 2(1):24–27Google Scholar
  11. 11.
    Brey JM, Conoley J, Canale ST, Beaty JH, Warner WC, Kelly DM, Sawyer JR (2012) Tibial tuberosity fractures in adolescents: is a posterior metaphyseal fracture component a predictor of complications? J Pediatr Orthop 32(6):561–566CrossRefGoogle Scholar
  12. 12.
    Wiss DA, Schilz JL, Zionts L (1991) Type III fractures of the tibial tubercle in adolescents. J Orthop Trauma 5(4):475–479CrossRefGoogle Scholar
  13. 13.
    Kaneko K, Matsuda T, Mogami A, Obayashi O, Iwase H, Kurosawa H (2004) Type III fracture of the tibial tubercle with avulsion of the tibialis anterior muscle in the adolescent male athlete. Injury 35(9):919–921CrossRefGoogle Scholar
  14. 14.
    Mosier SM, Stanitski CL (2004) Acute tibial tubercle avulsion fractures. J Pediatr Orthop 24(2):181–184CrossRefGoogle Scholar
  15. 15.
    Pace JL, McCulloch PC, Momoh EO, Nasreddine AY, Kocher MS (2013) Operatively treated type IV tibial tubercle apophyseal fractures. J Pediatr Orthop 33(8):791–796CrossRefGoogle Scholar
  16. 16.
    Skaggs DL (2006) Chapter 23, Extra-articular injuries of the knee. In: Beaty J, Kasser J (eds) Rockwood & Wilkins’ Fractures in children, 6th edn. Lippincott Williams & Wilkins, Philadelphia, pp 938–984Google Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Traumatology and Orthopaedic SurgeryHospital Clínico Universitario San CarlosMadridSpain

Personalised recommendations