IS Case 316: Avulsion fracture of the tibial tubercle
Imaging Sciences URMC 2009
Publication Date: 2009-09-14
History
Patient is a 15-year-old male with acute knee pain while playing basketball.
Diagnosis
Avulsion fracture of the tibial tubercle
Discussion
Avulsion of the tibial tubercle is an uncommon fracture of the tibia that occurs in adolescents. Patients usually give a history of forceful quadriceps contraction during knee extension, such as in jumping, or by acute passive flexion of the knee against a contracting quadriceps, like landing after a jump. Given this mechanism, the injury is usually associated with athletics. Differentiation from Osgood-Schlatter disease is essential if tibial tubercle avulsion is suspected.
Ogden's classification of tibial tubercle avulsion is as follows:
IA:Fracture distal to the junction of the ossification center of the proximal tibial epiphysis and tuberosity
IB:Type IA but communited
IIA:Fracture extension to the proximal tibial epiphysis but not to the joint
IIB:Type IIA but communited
IIIA:Fracture extends to the joint through the proximal tibial epiphysis
IIIB:Type IIIA but communited
IV:Fracture extension transversely through the proximal tibial physis
Treatment includes anatomic reduction of the fracture, return of extensor alignment, and obtain an adequate tibial articular surface. Closed reduction and immobilization is usually performed for Types IA, IB, and IIA fractures. Types IIB, IIIA and B, and Type IV should have an open reduction and internal fixation to return extensor alignment and to obtain good articular congruency. Prognosis is excellent but complications include genu recurvatum, patella baja, nonunion, malunion, compartment syndrome, and deep venous thrombosis.
References
- Mosier SM, Stanitski CL. Acute tibial tubercle avulsion fractures. J Pediatr Orthop. 2004 Mar-Apr;24(2):181-4. PMID: 15076604
- Hand WL, Hand CR, Dunn AW. Avulsion fractures of the tibial tubercle. J Bone Joint Surg Am. 1971 Dec;53(8):1579-83. PMID: 5121798
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