Tibial Tubercle Avulsion Fractures in Adolescents: A Narrative Review & Case Report

Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern. Case Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle. Discussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries.

Lesser Tuberosity Avulsion Fracture in an 11-Year-Old Baseball Player due to Batting

Case. We report an 11-year-old male who sustained a lesser tuberosity avulsion fracture of the proximal humerus upon making contact with a baseball during an at-bat. This injury was neglected for 14 months and was eventually detected by an axillary radiograph and subsequent MRI. He successfully underwent an open surgical repair and regained full range of motion and level of activity at 1-year follow-up. Conclusion. In pediatric baseball players, lesser tuberosity avulsion fractures may occur upon striking a baseball with a bat. Even after being neglected for several months, these injuries can be treated successfully with an open surgical repair.

Traumatic Avulsion Fracture of the Origin of the Brachioradialis Muscle: A Case Report and Review of the Literature

Avulsion fracture of the brachioradialis muscle origin at the proximal two-thirds of the lateral supraepicondylar ridge of the humerus is an extremely rare fracture with only 4 reported cases in the literature so far. In this article, we describe the case of a 50-year-old male patient who had sustained a closed fracture of the latter after falling from a height of 1.5 m on a flexed elbow and pronated hand. The patient was managed with immobilization of the elbow and wrist with a posterior splint in neutral position for 3 weeks, followed by wrist and elbow therapeutic mobilization sessions for 3 months. At the final follow-up, the patient had painless active and passive full range of motion of the elbow along with good flexion strength. The unique mechanism by which this avulsion fracture occurred is explained on the basis of the mode of injury, position of the limb, and structure and function of the brachioradialis muscle.