Physeal Type Tibial Tuberosity Fracture in an Adolescent

  • Cory Lebowitz
  • Richard W. Kruse
Living reference work entry


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.

References and Suggested Readings

  1. 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):561CrossRefPubMedGoogle Scholar
  2. Mencio GA, Marc Swiontkowski F (2014) Fractures around the knee in children. In: Green’s skeletal trauma in children, 5th edn. Elsevier Health Sciences, Philadelphia. 390436. PrintGoogle Scholar
  3. Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ (2012) Tibial tubercle fractures: complications, classification, and the need for intraarticular assessment. J Pediatr Orthop 32(8):749CrossRefPubMedGoogle Scholar
  4. Pretell-Mazzini J, Kelly DM, Sawyer JR (2016) Outcomes and complications of Tibial tubercle fractures in pediatric patients: a systemic review of the literature. J Pediatr Orthop 36(5):440CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Orthopedic SurgeryRowan University School of Osteopathic MedicinePhiladelphiaUSA
  2. 2.Department of OrthopaedicsNemours/Alfred I. DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Eric D. Shirley
    • 1
  1. 1.Pediatric Orthopaedic AssociatesAltantaUSA

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