Tibial tuberosity fractures in adolescents

Abstract

Background: Tibial tuberosity fractures in adolescents are uncommon. We retrospectively reviewed all tibial tuberosity fractures in adolescents (10-19) who presented to our level 1 pediatric trauma center over a 7-year period to review fracture morphology, mechanism of injury, fracture management including return to play, as well as complications. Additionally, we present a review of the literature and treatment algorithm.

Methods: We reviewed the clinical charts and radiographs of consecutive patients with tibial tuberosity fractures between 01 January 2000 and 01 January 2007. Data parameters included the following: patients age and gender, involved side, injury classification, co-morbidities, mechanism of injury, treatment, return to activity and complications. Data were extracted and reviewed, and a treatment algorithm is proposed with some additional insights into the epidemiology of the injury. Nineteen patients met the inclusion criteria.

Results: There were 19 patients with 20 tibial tuberosity fractures. The mean age was 13.7 years. There were 18 males and 1 female patient. There were nine left-sided injuries and eleven right-sided including one patient with bilateral fractures. Mechanism of injuries included basketball injury (8), running injury (5), football injury (3), fall from a scooter (2), high jump (1) and fall (1). Co-morbidities included three patients with concurrent Osgood-Schlatter disease and one with osteogenesis imperfecta. All were treated with ORIF, including arthroscopic-assisted techniques in two cases. Complications included four patients with pre-operative presentation of compartment syndrome all requiring fasciotomy, one post-operative stiffness and one painful hardware requiring removal. Range of motion was started an average of 4.3 weeks post-operatively and return to play was an average of 3.9 months post-operatively.

Conclusion: Although uncommon, tibial tuberosity fractures in adolescents are clinically important injuries. Early recognition and treatment (closed or open as appropriate) gives good results. All the patients in our series had surgical fixation as per different indications that have been elaborated. It is important for clinicians to recognize that compartment syndrome remains a significant concern post-injury and in the perioperative period. Close monitoring and timely intervention is recommended. A simple treatment algorithm is presented for clinicians to help manage these injuries.

Fig. 1

Arthroscopic images demonstrate ability to judge joint restoration, meniscal movement and assess joint cartilage

Fig. 2

a Plain radiograph AP view of a 14-year-old with type IIIB tibial tuberosity fracture. b Lateral radiograph of the same patient demonstrating a fragment comminution. c Six-month post-op AP radiograph of the same patient demonstrating fixation. d Lateral radiograph demonstrating union with good remodeling

Fig. 3

Tibial tuberosity algorithm. Modified Ogden classification of original classification provided by Sir Reginald Watson-Jones

Fig. 4

a Plain lateral radiograph of the right knee in a 13-year-old patient with a type IB tibial tuberosity fracture. b Plain lateral radiograph of the left knee in the same patient. c Nine-month follow-up of the same patient demonstrating fixation of the right knee. d Nine-month follow-up of the same patient demonstrating fixation of the left knee