Type III tibial tuberosity avulsion fracture – A niche injury type in athletic adolescents

Abstract text (incl. references and figure legends)

Case History: Tibial tuberosity fractures, or tibial tubercle fractures, amount to less than 1% of all paediatric fractures, but are common in the setting of adolescent athletic patients. Mechanisms of injury usually consist of either concentric contraction of the quadriceps while jumping, or eccentric quadriceps contraction during forced knee flexion. This is the case of a 14-year-old girl sustaining a type III tibial tuberosity fracture after a jump. Clinical Findings: Left knee effusion was evident, with associated pain and functional impotence with complete impairment of the extensor apparatus. X rays and CT scan confirmed a displaced tibial tuberosity fracture-avulsion, in the coronal plane, extending posteriorly to cross the primary ossification centre – a type 3 fracture according to modified Ogden classification. Results: Surgical treatment was performed – open reduction and internal fixation using cancellous lag screws with washers. Patellar tendon degloving was observed at its insertion site, and was repaired using 2 suture anchors. No other lesions were found. Extension splint was applied after wound closure. Therapy and Progressions: Weightbearing was not permitted until the knee splint was removed at 4 weeks post-op. Physical therapy was then instituted. At 9 months, the fracture was healed, and the patient was asymptomatic and back to sports – hardware removal was then carried out at 12 months. Comments: Prognosis of these fractures is usually good when correctly treated, with high rate of bon union and return to sports. The surgeon should be on alert for associated injuries, though, such as extensor apparatus lesions or intraarticular pathology. In around 4% of cases, compartment syndrome has been described, due to laceration of the recurrent anterior tibial artery – which did not occur in this case.

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