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Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update

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Abstract

Tibial tubercle fractures in adolescents are uncommon injuries which typically occur in 12–16 year-old males involved in athletic activities. We hereby present our experience in the surgical treatment of such lesion. By reviewing all the tibial tuberosity fractures treated surgically at our institution between January 2012 and January 2016, we were able to identify 12 patients (14 fractures), of which 11 males and 1 female, whose average age at the time of the trauma was of 14.05. According to the Ogden classification, we identified two Type IIA fractures, one Type IIB fracture, one Type IIIB fracture, four Type IIIC fractures, four Type IVA fractures, one Type IVB fracture and one Type IVC fracture. All patients underwent surgical treatment—9 fractures ORIF (64.3%), 5 CRIF (35.7%)—and postsurgical immobilization in plaster cast for 15 days, with a non-weight bearing period of approximately 4.7 weeks. They all had a complete ROM recovery and returned to preinjury activities within 4.1 months on average. The successful union of the fracture was observed in all patients, and no cases of meniscal lesions, compartment syndrome, infections, lower limb length discrepancy or axial deviations emerged at the minimum follow-up of 24 months. After an average period of 11 months and 2 weeks (range 6.1–16.3), all patients underwent surgical implant removal. Our experience matches the outcomes described in the literature, therefore confirming the safety and effectiveness of this treatment.

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References

  1. Hamilton SW, Gibson PH (2006) Simultaneous bilateral avulsion fractures of the tibial tuberosity in adolescence: a case report and review of over 50 years of literature. Knee 13(5):404–407

    Article  CAS  Google Scholar 

  2. Pretell-Mazzini J et al (2016) Outcomes and complications of tibial tubercle fractures in pediatric patients: a systematic review of the literature. J Pediatr Orthop 36(5):440–446

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  4. Jakoi A, Freidl M, Old A, Javandel M, Tom J, Realyvasquez J (2012) Tibial tubercle avulsion fractures in adolescent basketball players. Orthopedics 35(8):692–696

    Article  Google Scholar 

  5. Brey JM et al (2012) Tibial tuberosity fractures in adolescents: is a posterior metaphyseal fracture component a predictor of complications? J Pediatr Orthop 32(6):561–566

    Article  Google Scholar 

  6. Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ (2012) Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop 32(8):749–759

    Article  Google Scholar 

  7. 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 

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

    Article  Google Scholar 

  9. 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 

  10. Riccio AI et al (2017) Functional outcomes following operative treatment of tibial tubercle fractures. J Pediatr Orthop 00(00):1

    CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  12. Ryu RK, Debenham JO (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 

  13. 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 Ser A 72(9):1411–1413

    Article  CAS  Google Scholar 

  14. Ogden JA, Southwick WO (1976) Osgood-Schlatter’s disease and tibial tuberosity development. Clin Orthop Relat Res 72(9):1411–1413

    Google Scholar 

  15. Little RM, Milewski MD (2016) Physeal fractures about the knee. Curr Rev Musculoskelet Med 9(4):478–486

    Article  Google Scholar 

  16. Clarke DO, Franklin SA, Wright DE (2016) Avulsion fracture of the tibial tubercle associated with patellar tendon avulsion. Orthopedics 39(3):e561–e564

    Article  Google Scholar 

  17. Choi NH, Kim NM (1999) Tibial tuberosity avulsion fracture combined with meniscal tear. Arthroscopy 34(1):233–236

    Google Scholar 

  18. 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 

  19. 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 

  20. Lipscomb AB, Gilbert PP, Johnston RK, Anderson AF, Snyder RB (1984) Fracture of the tibial tuberosity with associated ligamentous and meniscal tears”. J Bone Joint Surg Ser A 66(5):790–792

    Article  CAS  Google Scholar 

  21. Pape JM, Goulet JA, Hensinger RN (1993) Compartment syndrome complicating tibial tubercle avulsion. Clin Orthop Relat Res 295:291–304

    Google Scholar 

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

    Google Scholar 

  23. 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 

  24. Abalo A, Akakpo-Numado K, Dossim A, Walla A, Gnassingbe K, Tekou A (2008) Avulsion fractures of the tibial tubercle. J Orthop Surg 16(3):308–311

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  26. Christie MJ, Dvonch VM (1981) Tibial tuberosity avulsion fracture in adolescents. J Pediatr Orthop 1(4):391–394

    Article  CAS  Google Scholar 

  27. Schiller J, DeFroda S, Blood T (2017) Lower extremity avulsion fractures in the pediatric and adolescent athlete. J Am Acad Orthop Surg 25(4):251–259

    Article  Google Scholar 

  28. Pace JL, McCulloch PC, Momoh EO, Nasreddine AY, Kocher MS (2013) Operatively treated type IV tibial tubercle apophyseal fractures. J Pediatr Orthop 33(8):791–796

    Article  Google Scholar 

  29. Roy SP, Nag K (2013) Simultaneous bilateral tibial tuberosity avulsion fractures in adolescence: Case report and review of 60 years of literature. Injury 44(12):1953–1955

    Article  Google Scholar 

  30. Nicolini AP, Carvalho RT, Ferretti M, Cohen M (2018) Simultaneous bilateral tibial tubercle avulsion fracture in a male teenager. J Pediatr Orthop B 27(1):40–46

    Article  Google Scholar 

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Authors and Affiliations

  1. UOC Ortopedia e Traumatologia Pediatrica, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy

    Federica Formiconi, Raffaele Dario D’Amato, Andrea Voto, Elena Panuccio & Antonio Memeo

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  1. Federica Formiconi
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  2. Raffaele Dario D’Amato
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  3. Andrea Voto
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  4. Elena Panuccio
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  5. Antonio Memeo
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Correspondence to Federica Formiconi.

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Formiconi, F., D’Amato, R.D., Voto, A. et al. Outcomes of surgical treatment of the tibial tuberosity fractures in skeletally immature patients: an update. Eur J Orthop Surg Traumatol 30, 789–798 (2020). https://doi.org/10.1007/s00590-020-02629-y

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