To begin, provisional fixation was achieved with two Kirschner wires. We describe a unique case of tibial tuberosity avulsion fracture in an adult with PDB. Epidemiology /Etiology. Treatment was successful with cannulated screws and tension band wiring. Potential mechanisms: There are multiple classification systems with multiple modifiers. Treatment was guided in part by evidence on fixation after tibial tubercle osteotomy; in that context, screw fixation is likely superior to wire fixation [9]. DOI: 10.2106/00004623-197759080-00022 Corpus ID: 2637082; Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. The normal ossification of the tibial tuberosity occurs from two centers, one distal and one proximal. 3. An official website of the United States government. and transmitted securely. We describe a case in an adult who suffered a left knee injury due to a fall from height. The site is secure. Diagnosis can be confirmed with radiographs of the knee. https://www.ncbi.nlm.nih.gov/pubmed/17571833, https://www.sciencedirect.com/science/article/abs/pii/S2210794013000060?via%3Dihub, https://www.ncbi.nlm.nih.gov/pubmed/?term=Avulsion+fracture+of+the+tibial+tubercle+with+avulsion+of+the+patellar+ligament.+Report+of+two+cases, https://europepmc.org/article/med/6216535, https://www.ncbi.nlm.nih.gov/pubmed/2225644. Osgood-Schlatter disease (OSD) is one of the most common causes for anterior knee pain in children. (B) Intraoperative patella altaevident after suture tensioning. Avulsion of the Tibial Tubercle. government site. The unique construct, a slotted-plate over transosseous sutures, provided excellent results and likely has further applications. Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring. An anterior midline approach was used. Learn more here. Associations patella tendon or quadriceps tendon rupture Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. Regarding combined lesions, in adolescents it has been proposed that tubercle avulsion is followed by rotation, which tensions soft tissues around the tubercle, arresting fragment translation; continued quadriceps contraction then causes tendon avulsion [5,6]. In adolescents, combined lesions have been treated using a variety of methods, including staples, wires or suture tape, tension banding, lag screws, suture anchors, and/or transosseous sutures [6,8]. HHS Vulnerability Disclosure, Help (D) One year postoperative,slight osseous debris or ossification (arrow) can be seen in the area of the patellar tendon. 1 This traumatic lesion is typical of the growth age, when muscles, tendons and ligaments are stronger than the growth plate. In this anatomic location, aone-third semitubular plate was low profile and allowed for easy contouring to the convex surface of the anterior tibia. In young athletes, the growth center there is still open, leaving it vulnerable to injury. 1995;81(7):635-8. Tibial Tubercle Fractures are common fractures that occur in adolescent boys near the end of skeletal growth during athletic activity. Scholarly Impact Quotient (SIQ) is our unique post-publication peer review rating process. X-rays in anteroposterior and lateral views of the left knee showing the tibial, Images of the knee during the surgery, showing the gap in the tibial. Tubercle avulsion is considerably more common in adolescents than that in adults due to the weakness of an open physis although tubercle fracture may also occur in adults, typically as a result of direct impact [1,4]. 6-16 There was one case report of a tibial tubercle avul-sion fracture and a tibial spine avulsion fracture with no rupture of the patella tendon.17 This An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. However, screws may have limited purchase in small fragments or osteoporotic bone and may even cause fragment splitting [13]. The typical patient is an adolescent male approaching skeletal maturity with well-developed quadriceps. Silva Jnior AT, Silva LJ, Silva Filho UC, Teixeira EM, Arajo HR, Moraes FB. Treatment was guided in part by evidence on fixation after tibial tubercle osteotomy; in that context, screw fixation is likely superior to wire fixation [9]. Tibial tuberosity avulsion fractures are uncommon. Tibial Plateau Fracture with Avulsion Fracture of Tibial Tuberosity: A Case Report and Review of Literature. Accessibility Ultrasonography demonstrated an intact quadriceps tendon and a normal patellar tendon origin at the inferior patellar pole. Patellar height ratios: a comparison of four measurement methods. We describe a case of a patient with undiagnosed Paget's Disease of the bone, sustaining a pathological avulsion fracture of the tibial tuberosity. (B) The plate was then secured atop the tubercle fragment. The mechanism of the trauma usually is the avulsion of the tubercle for the eccentric contraction of the thigh. We are experimenting with display styles that make it easier to read articles in PMC. In patients with radiographic evidence of tibial tubercle fracture, lateral flexion extension radiographs, ultrasonography, and/or magnetic resonance imaging are prudent to rule out concomitant patellar tendon avulsion [5,6]. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. Before Rana R, Ganesh A, Behera S 2nd, Behera H. Cureus. Nikiforidis PA, Babis GC, Triantafillopoulos IK, Themistocleous GS, Nikolopoulos K. Knee Surg Sports Traumatol Arthrosc. 1. Puppies diagnosed with this type of fracture usually have had some sort of trauma such as falling from a couch or bed and landing with the knee flexed. doi: 10.1097/MD.0000000000001684. Avulsion fractures of the tibial tuberosity in the adult are extremely rare with only 3 reported cases. Whiteside LA, Ohl MD. BACKGROUND Fractures of the tibial tuberosity are rare, taking only 3% of the proximal tibial fractures.1 This traumatic lesion is typical of the growth age, when muscles, tendons and ligaments are stronger than the growth plate. Right knee lateral radiograph from five years ago revealing similar picture to Figure 1. What are Tibial Tuberosity Avulsion Fractures? Tibial tubercle avulsion fracture with simultaneous patellar tendon avulsion is a rare injury that has only ever been reported in adolescents; the diagnosis and management of this combined lesion has not been described in the adult population. Ultrasound demonstrating tibial tubercle (TT) fracture with proximal migration of the patellar tendon and tubercle fragment. Recovery and aftercare There is a low risk of fracture after MMP surgery , so strict cage rest and keeping your dog on their lead when not in the cage is a must for the first 4-6 weeks. (B) Intraoperative patella altaevident after suture tensioning. "Never doubt that a small group of thoughtful, committed citizens can change the world. Anything above 5 should be considered above average. Causes of knee pain and the general . and 2004. the incidence of adult avulsion fractures may be underestimated.1 Ten case reports, including 17 patients, of ipsilateral simultaneous rupture of the pa-tella tendon and ACL have been reported. Avulsion fractures of the tibial tubercle. Journal of Children's . Introduction: (A) Intraoperative fluoroscopydemonstrating plate fixation of the tibial tubercle with slots cut in plate (arrows) for passing over sutures. At one year, the patient had achieved excellent range of motion (full extension to 135 degrees of flexion) and strength (5/5 knee flexion and extension) without residual pain or complications. All patients require a variable period of immobilization averaging 4 weeks. Clinical Findings: Patients usually have a history of injury and pain in the anterior knee. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Rev Chir Orthop Reparatrice Appar Mot. The patient had full active range of motion (full extension to 135 degrees) andstrength(5/5) equivalent to the uninjured knee, with no residual pain, hardware irritation, or bursitis. Treatment may be nonoperative or operative depending on location of the fracture, degree of displacement, and any associated injuries. Regarding combined lesions, in adolescents it has been proposed that tubercle avulsion is followed by rotation, which tensions soft tissues around the tubercle, arresting fragment translation; continued quadriceps contraction then causes tendon avulsion [5,6]. Disclaimer, National Library of Medicine (D) One year postoperative,slight osseous debris or ossification (arrow) can be seen in the area of the patellar tendon. Liu, Y.-P., Hao, Q.-H., Lin, F., Wang, M.-M., & Hao, Y.-D. (2015). One case of fracture of the tibial tuberosity in the adult. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Radswiki T, Fortin F, Sharma R, et al. Avulsion fractures are caused by trauma. Previously, isolated distal patellar tendon avulsions have been treated with transosseous sutures or suture anchors [2,3]. 2 (6): 469-74. Integrity of the distal patellar tendon could not be determined due to hematoma at the site of tendon attachment to the tibial tubercle (arrow). The proximal center has a physis and is a cartilaginous extension of the tibial epiphysis which expands distally. One year following surgery, the patient had full knee range of motion (full extension to 135 degrees of flexion) and full flexion and extension power (5/5) with no residual pain or other complications. Tubercle avulsion is considerably more common in adolescents than that in adults due to the weakness of an open physis although tubercle fracture may also occur in adults, typically as a result of direct impact [1,4]. (C) Three months postoperative, patella height is appropriate and with visible pilot-hole lucency (arrow) from transosseous suture placement. Despite being the result of a relatively low-energy mechanism, the patient had no known risk factors for tendon rupture. The tendon in turn pulls on the tibial tuberosity. Pesl T; Havranek P. Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method. An articles SIQ will appear alongside the article after being rated twice and is recalculated with each additional rating. Tibial tubercle fracture with avulsion of the patellar ligament: a case report. This site needs JavaScript to work properly. Tibial tubercle avulsion fracture with simultaneous patellar tendon avulsion is a rare injury that has only ever been reported in adolescents; the diagnosis and management of this combined lesion has not been described in the adult population. Bookshelf While a peak in boys. official website and that any information you provide is encrypted Disclaimer, National Library of Medicine This injury typically occurs in adolescents because the tibial tubercle is still growing and the bone is softer there. Initial treatment consists of medications . You may switch to Article in classic view. Mechanism of injury of a tibial tubercle fracture AP radiograph of the knee taken three weeks postoperatively showing fixation with cannulated screws and tension band wire. All content published within Cureus is intended only for educational, research and reference purposes. Images of the inferior limb demonstrating the functional assessment after the treatment. Images of the knee during the surgery, showing the gap in the tibial tubercle by the fracture and the reinsertion position. When the quadriceps muscle on the front of the thigh works, it pulls on the patellar tendon. Woolnough T, Lovsted G, Macdonald A, et al. This is the first reported case of a tibial tubercle fracture with simultaneous avulsion of the distal patellar tendon in an adult. Avulsion fracture the tibial tuberosity occurs in a young animal, usually between 4-8 months of age. Right knee AP radiograph showing avulsion fracture of the tibial tuberosity. Diagnosis can be confirmed with plain radiographs of the knee. (May 02, 2020) Combined Tibial Tubercle Fracture With Patellar Tendon Avulsion in an Adult: A Rare Case and Novel Fixation Technique. (C) Transosseous sutures through the donor site (metal probe) and tubercle fragment (lower arrow), secured to the patellar tendon with a running-locking technique (upper arrow). 2009 Dec 19;2:9357. doi: 10.1186/1757-1626-2-9357. Insall J, Salvati E. Patella infera. How do you get tibial tuberosity? Medicine (Baltimore). At one year, radiographs were unremarkable other than minimal osseous debris and/or ossification (Figure 5D). This occurs as tendons can bear more load than the bone. This injury pattern accounts for less than 1% of all pediatric fractures and is even less common in adult . Distal patellar tendon avulsion in association with high-energy knee trauma: a case series and review of the literature. The second method involves fixation by lag screws with or without tension band wiring as an augment fixation. (C) Three months postoperative, patella height is appropriate and with visible pilot-hole lucency (arrow) from transosseous suture placement. Review of final fluoroscopic images confirmed reduction of the tubercle and showed patella baja (Figures (Figures5A,5A, ,5B).5B). Extensor mechanism reconstruction and joint preservation surgery following a tibial tuberosity fracture in giant cell tumor of bone: A case report. 2013: bcr2013202411. The mechanism of the trauma usually is the avulsion of the tubercle for the eccentric contraction of the thigh. PMC Acute tibial tubercle avulsion fractures. Epidemiology The distal aspect of the patellar tendon could not be fully visualized by ultrasound due to overlying hematoma, but proximal retraction was noted (Figure (Figure22). Avulsion fractures of the tibial tuberosity represent 3% of all epiphyseal plate injuries in adolescents. The sutures were tensioned and locked, reducing the patellar tendon to the bony fragment and tibia. At three months, radiographs demonstrated appropriate patellar height(Figure 5C); the patient had active range of motion from full extension to 120 of flexion with only mild discomfort. Tibial tuberosity avulsion fracture. Fukuoka Igaku Zasshi. After six weeks, knee range of motion was gradually increased using a hinged brace. Radiographs demonstrated a displaced fracture of the tibial tubercle; patellar tendon integrity could not be verified by ultrasonography. 8600 Rockville Pike doi: 10.7759/cureus.7756. The patient had full active range of motion (full extension to 135 degrees) andstrength(5/5) equivalent to the uninjured knee, with no residual pain, hardware irritation, or bursitis. Plate fixation provided the strength of screw fixation while avoiding potential fragment splitting or loss of screw purchase. Accessibility Modified Ogden classification (modification of Watson-Jones classification): Recommended views include an AP and lateral knee radiograph. However, the first presentation of this injury in an adult represented a unique challenge as no literature existed describing successful management. type IV: "beak" fracture but with a small triangular fragment separated by deep . chronic renal failure, diabetes, chronic steroid use, quinolone treatment, systemic lupus erythematous) may increase risk of tendon rupture, this patient reported no known risk factors [3,4]. Of these, 83 (65.4%) cases were PM and 44 were other fractures. Tibial tubercle avulsion fracture with simultaneous patellar tendon avulsion is a rare injury that has only ever been reported in adolescents; the diagnosis and management of this combined lesion has not been described in the adult population. Caldwell PE, Bohlen BA, Owen JR, et al. The third method involves anchor suture. 1971;53(8):15791583. 2008 Jul;111(7):548-52. doi: 10.1007/s00113-007-1371-y. 2012;35(8):692696. A healthy 62-year-old male presented with acute knee pain and an inability to walk after a fall on ice. The slotted plate design allowed precise transosseous suture placement, unobstructed by prior bony fixation. Cureus 12(5): e7929. Apropos of 128 cases. Patients with PDB who fracture present with diagnostic and operative challenges, it is vital to progress with caution in the postoperative rehabilitation phase. 2. Before doi: 10.7759/cureus.13256. Fixation with a slotted-plate construct has promising applications outside of the present case, particularly in the setting of tibial tubercle osteotomies and knee arthroplasty where the screws of this construct may be angled to avoid the intramedullary canal, bypassing stemmed or keeled tibial implants. The primary fixation was reinforced using a third #5 polyester suture, placed through an additional transosseous pilot hole distal to the fracture site and secured to the tendon again using a Krackow technique (Figures (Figures4C,4C, ,4D).4D). Adult fracture; Bone fragility; Paget's disease of the bone; Tibial tuberosity fracture. landing from a jump, violent quadriceps contraction against a fixed foot, e.g. Keywords: Any adolescent is at risk who participates in activity that can exceed the strength of the tibial tubercle by the quadriceps muscle contracting. It might take up to 12 weeks for you to fully heal. A novelslotted-plate construct was used to fix the tubercle fragment prior to tightening the sutures. Federal government websites often end in .gov or .mil. The development of Osgood-Schlatter's is associated with the time of rapid growth and immature bone maturation in early teen years. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. We describe a case in an adult who suffered a left knee injury due to a fall from height. nowadays. After excising hemorrhagic prepatellar bursa, evacuating overlying traumatic hematoma, and exposing the fracture donor site (Figure 3A), it was apparent that in addition to the tibial tubercle fracture, the patellar tendon was completely avulsed from the tubercle fragment (Figure 3B). Berg EE, Mason SL, Lucas MJ. An official website of the United States government. - Follow-up study of arthroscopic reduction and fixation of type III tibial-eminence fractures. The site is secure. Combined Tibial Tubercle Fracture With Patellar Tendon Avulsion in an Adult: A Rare Case and Novel Fixation Technique, Neurological Complications in Post-COVID-19 Infected Patients: A Case Series, Successful Desensitization to the Radiocontrast Material Iohexol (Omnipaque), Relapsing Kikuchi-Fujimoto Disease With Hemophagocytic Lymphohistiocytosis, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings, Distal patellar tendon avulsion in association with high-energy knee trauma: a case series and review of the literature, Complete avulsion of the patellar tendon from the tibial tubercle in an adult without predisposing factors, Bifocal disruption of the knee extensor mechanism: a case report and literature review, Tibial tubercle fracture with avulsion of the patellar ligament: a case report, Tibial tubercle fracture with avulsion of patellar ligament, Avulsion fracture of the tibial tubercle with avulsion of the patellar ligament. This can occur in vigorous sports activities that require frequent . Careers. 51 (5): 610-613. Rana R, Ganesh A, Behera S 2nd, Behera H. Cureus. Review of final fluoroscopic images confirmed reduction of the tubercle and showed patella baja (Figures 5A, 5B). 2015 Jun;106(6):206-11. Optional views include an internal rotation view bringing the tibial tuberosity into profile or a contralateral knee radiograph for comparison. Orthopedics. SIQ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. The avulsion fracture of the tibial tuberosity is regarded as a substantial injury to the extensor mechanism as the patellar tendon is attached to the tibial tuberosity. Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. doi: 10.7759/cureus.20232. They are often associated with patients who have underlying bone disease and other medical co-morbidities. Case report: A 54-year-old male presented with right knee pain after his knee gave way whilst standing in the goal area during a game of football, twisting his right ankle and falling. The patient was healthy and denied previous trauma, and corticosteroid or quinolone use. We describe a case of a patient with undiagnosed Paget's Disease of the bone, sustaining a pathological avulsion fracture of the tibial tuberosity. (D) Completed fixation with the tubercle fragment reduced,plate secured(white arrow, not visible), and the tendon reduced. Examination of the left knee revealed a compromised extensor mechanism and a palpable defect at the inferior insertion of the patellar tendon, with diffuse pain and swelling but no neurovascular or skin compromise. Whereas older adults would sustain a patellar tendon tear, growing athletes sustain this uncommon injury. A tibial tubercle fracture is a break or crack at this location, which usually occurs as a result of the patellar tendon pulling off a piece of the bone. While systemic illness (e.g. 5. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. The patellar height ratio (0.8) was within normal limits using both Caton-Deschamps (normal 0.8-1.2) and Insall-Salvetti (0.75-0.99)methods [10-12]. Human subjects: Consent was obtained by all participants in this study. The ePub format uses eBook readers, which have several "ease of reading" features chronic renal failure, diabetes, chronic steroid use, quinolone treatment, systemic lupus erythematous) may increase risk of tendon rupture, this patient reported no known risk factors [3,4]. We describe a case in an adult who suffered a left knee injury due to a fall from height. Integrity of the distal patellar tendon could not be determined due to hematoma at the site of tendon attachment to the tibial tubercle (arrow). Rev Chir Orthop Reparatrice Appar Mot. Avulsion of the tibial tuberosity is not an uncommon entity seen in adolescents. Taylor Woolnough, Gwendolyn Lovsted, [], and Jamal A Al-Asiri. . On univariate analysis, the PM fractures were associated with fibular spiral (p=-016) fractures and no fracture of the fibular (p=.003), lateral direction of the tibial fracture (p=.04), female gender (p=.002), AO classification 42B1 (p=.033) and an increasing angle of tibial fracture. Fractures of the tibia may result from significant trauma or be the consequence of repeated overuse. At this point, slots were cut into the central two holes of a four-hole, 3.5-mm one-third tubular plate. Patella position in the normal knee joint. Tuberosity is the term used to describe the prominence of a bone that attaches the ligament to the bone. A combined lesion - tubercle fracture with patellar tendon avulsion from the tubercle fragment - has only ever been reported in adolescents, typically those involved in sport, and can present challenges in both diagnosis and management [4-9]. Plain radiographs of the knee revealed an avulsion fracture of the tibial tuberosity with abnormal modelling of the proximal half of the tibia. [ 1, 2, 3, 4, 5, 6] activities involving powerful contraction of the knee. The tibial tuberosity serves as the insertion point of the quadriceps muscles through the patellar ligament, and avulsion results from the contraction of the muscle while stifling is flexed and the foot firmly on the ground, Such mechanism could . This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. It has been estimated that fractures of the patella occur at a rate of 1% of all total . 1-3 It has not been reported with proximal tibial diaphyseal fractures. Capogna B, Strauss E, Konda S, Dayan A, Alaia M: Kang S, Chung PH, Kim YS, Lee HM, Kim JP: Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. The typical patient is an adolescent male approaching skeletal maturity with well-developed quadriceps. This mechanism is plausible in our patient as radiographs demonstrated rotation and translation of the bony fragment. An overview of traumatic tibial fractures in adults with a focus on epidemiology and complications is presented here. You may notice problems with A Tibial Eminence Fracture, also known as a tibial spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. One year following surgery, the patient had full knee range of motion (full extension to 135 degrees of flexion) and full flexion and extension power (5/5) with no residual pain or other complications. (2004) Journal of pediatric orthopedics. This injury is a very rare event in adults, with only a few cases . Right knee lateral radiograph showing avulsion fracture of the tibial tuberosity. -. Avulsion of the tibial tuberosity is not an uncommon entity seen in adolescents. This mechanism is plausible in our patient as radiographs demonstrated rotation and translation of the bony fragment. HHS Vulnerability Disclosure, Help 4-6 Both fractures require operative . MRI scan revealing marked Pagets disease of the proximal tibia. Why Mechanism Matters: A Literature Review of Simultaneous Ipsilateral Tibial Tuberosity Avulsion and Patella Fracture With Case Report. They account for only 1% of pediatric fractures (Pandya, 2012). The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture. What are Tibial Tuberosity Fractures? The first method involves non-operative treatment with casting or bracing in non-displaced and stable fracture. However, the first presentation of this injury in an adult represented a unique challenge as no literature existed describing successful management. government site. . If the tension is too great and occurs too often while the bone is developing, it can pull the growth area of the tibial tuberosity away from the growth area of the . The lesion was . First, the tendon was secured to the tubercle fragment with transosseous sutures. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Simple Fracture : A break in a bone without an accompanying wound at the fracture site. Fixation with a slotted-plate construct has promising applications outside of the present case, particularly in the setting of tibial tubercle osteotomies and knee arthroplasty where the screws of this construct may be angled to avoid the intramedullary canal, bypassing stemmed or keeled tibial implants. Tibial tuberosity fractures affect the patellar ligament near the kneecap. This injury is a very rare event. type III: infrabursal avulsed fracture by superficial fibers from the middle third of the posterior tuberosity. The tibial tubercle is the bony attachment on the large bone of the lower leg (tibia) of the big, powerful thigh muscle (quadriceps). Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. MeSH Bethesda, MD 20894, Web Policies 2021 Dec 7;13(12):e20232. type I: simple extra-articular avulsion fracture. In adults, this injury is exceedingly rare, with only several reported cases. INTRODUCTION. Rodrigo Pires e Albuquerque, Andr Siqueira Campos, Gabriel Costa Serro de Arajo, Vincius Schott Gameiro. It is a traction apophysitis of the proximal tibial tubercle at the insertion of the patellar tendon. Typically caused by injuries from sporting activities involving jumping, most commonly basketball. Tibial tubercle fracture with avulsion of patellar ligament. Orthop Clin North Am. An open reduction and internal fixation of the tibial tubercle using a cortical screw and tension-band wire and patient had a good functional recovery after Six weeks of follow up. 2020 Apr 21;12(4):e7756. The ePub format is best viewed in the iBooks reader. The lesion was treated with surgical reduction and internal fixation. A tibial tubercle fracture is an uncommon knee injury in young athletes. J Knee Surg. Orthopedics, McMaster University, Hamilton, CAN. Compartment syndrome complicating tibial tubercle avulsion. This article is for Medical Professionals. Incidence. In adolescents, combined lesions have been treated using a variety of methods, including staples, wires or suture tape, tension banding, lag screws, suture anchors, and/or transosseous sutures [6,8]. INTRODUCTION. Int J Surg Case Rep. 2022 Jun 20;96:107326. doi: 10.1016/j.ijscr.2022.107326. Fractures of the knee . Despite being the result of a relatively low-energy mechanism, the patient had no known risk factors for tendon rupture. (B) Freeedge of the avulsed patellar tendon with no remaining bony attachment (arrow). When the fracture happens, the tendon or ligament pulls away, and a small piece of. 2021 Feb 10;13(2):e13256. CT is helpful to determine intra-articular or posterior extension. Atraumatic avulsion of the tibial attachment of patellar tendon in adults is a very rare injury with only few published case reports. doi:10.7759/cureus.7929, Received by Cureus: March 30, 2020 This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Tibial tuberosity avulsion fracture usually occurs in younger dogs due to the area of the tibia not being fully fused to the rest of the bone. What causes this injury? An avulsion fracture of the tibial tuberosity is an infrequent injury and has an extremely low occurrence in adults, with only a few cases reported in literature. Dynamic confirmation of fixation techniques of the tibial tubercle osteotomy. Unfallchirurg. An anterior midline approach was used. Exact cause is unknown but chronic repetitive trauma to the maturing proximal tibial growth plate by excessive force exerted on the secondary ossification center or apophysis by the patellar tendon leading to avulsion and tibial fragmentation with soft-tissue swelling of tubercle.. How do you treat Osgood-Schlatter in adults? Orthop. Generating an ePub file may take a long time, please be patient. 2015 Sep;94(39):e1684-0. Plate fixation provided the strength of screw fixation while avoiding potential fragment splitting or loss of screw purchase. Compound or Open Fracture : A break where the bone has penetrated the skin to the exterior, or the wound that broke the bone has exposed the broken ends. Frey S, Hosalkar H, Cameron DB, Heath A, David Horn B, Ganley TJ. The Orthopedic Clinics of North America. Acute tibial tubercle avulsion fractures. aged 12-15 years old was well documented, there seems to be no difference in sex distribution. Radiographs demonstrated tibial tubercle avulsion fracture and patella alta (Figure 1). Ultrasound demonstrating tibial tubercle (TT) fracture with proximal migration of the patellar tendon and tubercle fragment. Avulsion injuries are common among participants in organized sports, especially among adolescent participants. The tubercle fragment was translated 1.5 cm proximally and rotated 90 (Figure (Figure1A1A). The sutures were tensioned and locked, reducing the patellar tendon to the bony fragment and tibia. They usually happen when a bone is moving one way, and a tendon or ligament is . Combined Tibial Tubercle Fracture With Patellar Tendon Avulsion in an Adult: A Rare Case and Novel Fixation Technique, Monitoring Editor: Alexander Muacevic and John R Adler. 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. The .gov means its official. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. At this point, slots were cut into the central two holes of a four-hole, 3.5-mm one-third tubular plate. 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