ADOLESCENCE TIBIAL TUBERCLE AVULSION FRACTURE: OPTION OF SURGICAL TREATMENT IN WORSENING CONDITION OF PRE-EXISTING OSGOOD-SCHLATTER DISEASE (OSD)

Background: Osgood-Schlatter disease (OSD) is the most frequent cause of chronic knee pain in adolescents. Tibial tubercle avulsion fractures are an infrequent injury, approximately between 0.4-2.7% of all epiphyseal injury. Even though the relation between OSD and tibial tubercle avulsion fracture is still controversial, there are cases previously reported with this presentation.Case Report: A 16-years-old boy complained of pain on his left knee, significantly below the patella with ambulation limitation. He had a two-months history of knee pain in the same location and prominence on the area below the patella that was getting more significant over time. The patient was actively involved in volleyball in his school. The radiographic findings show fragmented tubercle fractures on the left tibial, soft tissue swelling in the tubercle's anterior side, and increased density of the infrapatellar fat pad. The patient underwent ORIF with screws. After a one-month post-surgery, the patient felt minimal pain when bending his left knee.Discussion: Male adolescents (12-15 years) and repetitive sprinting and jumping sports are the risk factors for OSD. About 90% of cases show a complete resolution, but some conditions make the OSD worse, such as low compliance at exercise avoidance. Surgery is rarely indicated for OSD, but in the condition of, even though very uncommon, tibial tubercle avulsion fracture, surgery gives a better outcome and resolution.Conclusion: All Osgood-Schlatter disease' patients should temporarily restrict sports activities to prevent tibial tubercle avulsion fractures.

Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents

BackgroundTibial tubercle avulsion fracture is rare in children. Accumulated knowledge on clinical and epidemiological features of this fracture is of practical significance for clinical colleagues to deal effectively with such fractures.MethodsClinical and epidemiological parameters were reviewed retrospectively in 29 patients with tibial tubercle avulsion fracture that was treated in our hospital in the past 7 years.ResultsTotally, 29 children with 30 tibial tubercle fractures were enrolled. They were all boys; the average age was 13.8 (12–15) years, and the average Body Mass Index (BMI) was 26.4 (19.2–34.3). Statistically, 41.4% of injuries occurred during jumping activities, and 1 (3.4%), 12 (41.4%) and 16 (55.2%) patients were injured bilaterally, on the right and left sides, respectively. The patients were classified into type I (4), II (3), III (13) and IV (10) fractures. Two patients (three knees) with fractures of type IV received close reduction and cast immobilization for 6 weeks. One patient with fracture of type IV underwent close reduction and was fixed with two cannulated screws. The remaining 26 patients underwent open reduction and were fixed with two or three cannulated screws. The average follow-up time was 38 (14–98) months; no complication was noted. Twenty-seven patients had an excellent outcome.ConclusionIn Chinese adolescents, the tibial tubercle avulsion fracture predisposes to boys with higher body weight; jumping is the most common cause of injury; treatments show satisfactory outcome regardless of fracture types.

Tibial tubercle avulsion fracture with concomitant reversibile foot paresis in adolescent

Cilj: Cilj rada bio je prikazati da i manje traume u adolescentno doba mogu uzrokovati avulziju tuberositasa tibije te ukazati na mogućnost nastanka kompartment sindroma. Prikaz slučaja: Kod dječaka u dobi od 15 godina pri promjeni smjera kretanja došlo je do avulzije tuberositasa tibije. Ozljeda je popraćena velikim edemom. Nakon operacije razvila se pareza peronealnog živca koja je uz medikamentoznu i fizikalnu terapiju regredirala u cijelosti. Zaključak: Pri sumjnji na avulziju tuberositasa tibije potrebna je žurna dijagnostika i liječenje. Zbog mogućeg nastanka sindroma kompartmenta potreban je pojačan nadzor u perioperacijskom periodu.

Complete Traumatic Trifocal Failure of the Extensor Mechanism of the Knee: A Case Report and Review of the Literature

The unique case of a rare 3-level extensor mechanism failure in a 28-year-old male, involving a tibial tubercle avulsion fracture, a patellar tendon avulsion off the tibial tubercle fragment, and a severely comminuted patella fracture, and the surgical technique required to repair such an injury is presented. Focus is spent on the unique repair of a tendon injury when both proximal and distal bony attachments are damaged. Trifocal knee extensor mechanism is a rare clinical entity with minimal literature available—to date, this injury has only been reported in a retrospective review of combat-related injuries in military personnel. It is important to maintain an understanding of knee extensor mechanism anatomy and perform thorough investigation of high-energy knee injuries to ensure adequate treatment of all injuries. The outcome presented in this case shows that positive results after complex extensor mechanism injuries may be achieved, but limited data exists to elucidate optimum treatment. It is essential for surgeons to have firm grasp of techniques used to treat each segment of the extensor mechanism so that they may be combined when a patient presents with complex, multifocal injury.

Tibial Tubercle Avulsion Fracture with Multiple Concomitant Injuries in an Adolescent Male Athlete

Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing failure of the physis at the patellar tendon insertion. This injury has been previously reported with various concomitant injuries, such as compartment syndrome from bleeding into the anterior compartment, vascular injury, patellar tendon avulsion, and meniscal injury—exhibited only with fracture types that extend intra-articularly. We report the case of a 14-year-old healthy adolescent male basketball player who sustained this injury as a result of a collision with another player. He initially reported to the emergency department and then presented to our practice, where he was diagnosed with a tibial tubercle avulsion fracture with patellar tendon rupture. During the operative management of these injuries, it was noted that fascial tissue avulsed through the injury site causing subacute extensive bleeding within the anterolateral compartments. Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. By five months postoperatively, the patient demonstrated near-normal function, no evidence of extensor lag, and nearly full range of motion. Unlike previously reported cases, this is the first report of a patient who suffered such an injury with multiple concomitant injuries to the neighboring structures. Due to the severity of compartment syndrome and the variability in its temporal presentation from the initial injury, it is paramount that careful evaluation of vascular integrity and a low threshold for fasciotomy be in place to prevent vascular compromise.