Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease

William R Howarth, Hilton P Gottschalk, Harish S Hosalkar
Journal of Children's Orthopaedics 2011, 5 (6): 465-70

BACKGROUND: Tibial tubercle fractures often occur in athletic adolescents close to skeletal maturity. These fractures can present with marked displacement of the apophysis, intra-articular extension, and associated soft tissue injuries, such as tibial meniscal ligament tears. Here, we present our surgical technique which focuses on recreating the meniscal-articular relationship (using suture anchors) in severely displaced fractures.

METHODS: We retrospectively reviewed all tibial tuberosity fractures treated with this technique over the last 2.5 years. Fractures with a minimum of a 12-month follow-up post-fixation were identified. Clinical records and radiographs were reviewed. Data included patient age, gender, involved side, injury classification (modified Ogden), mechanism of injury, treatment, return to activity, and complications.

RESULTS: Six patients met the inclusion criteria. Mean age at time of surgery was 14.9 (range 13.2-16.8) years. All patients were male and the mean follow-up period was 14 (12-26) months. Range of motion was started at 4 weeks post-operatively in a hinged knee brace, and return to sports occurred at an average of 3.75 months postoperatively (range 3-5 months). No evidence of growth disturbance of the proximal tibia or recurvatum at final follow-up was evident.

CONCLUSION: We speculate that patients who sustain a tibial tubercle avulsion fracture types III or V will likely have intra-articular pathology, specifically capsular avulsion or coronary ligament disruption. By utilizing suture anchors, our technique emphasizes renewing the anatomic articular environment to ensure better long-term results and maintaining these active individuals in sports.

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