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Zhang MR, Zeng X, Xie QJ, Chen HY. An unusual Ogden type V tibial tubercle avulsion fracture: a case report and literature review. J Med Case Rep 2024; 18:441. [PMID: 39272123 PMCID: PMC11401400 DOI: 10.1186/s13256-024-04778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/14/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Ogden type V tibial tubercle avulsion fracture is an unusual type of physial injury. Thus, little is known about its mechanism of injury and treatment. The type of osteosynthesis is variable and depends on the experience of the surgeon. We commonly used cancellous screws fixation combined with tension band wiring for displaced fracture of the anterior tibial tuberosity. CASE PRESENTATION The present manuscript describes a case of a Han nationality 13-year-old boy who presented with severe pain of the left knee, which began after landing following a high jump. He had no significant past medical history apart from a high body mass index of 30.3. Radiographs revealed that he had an unusual Ogden type V tibial tubercle avulsion fracture. He was treated by open reduction and combined fixation with cannulated screws and tension-band wiring. After 3 months, the fracture healed without any complications or knee symptoms with full range of motion. He underwent reoperation for symptomatic hardware, which was removed at 5 months after initial surgery, and returned to his prior level of sporting activity at 1 year follow-up. CONCLUSION Our case suggests that excellent functional outcome could be achievable by open reduction with the combination of internal fixation and tension-band wiring for Ogden type V tibial tubercle avulsion fracture. This type of osteosynthesis could not only achieve anatomical reduction and stable fixation for such fractures, but also avoid further damage to the proximal tibial epiphysis, which prevents serious complications, such difference in leg length.
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Affiliation(s)
- Mei-Ren Zhang
- Guangzhou University of Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, 519015, Guangdong Province, China.
| | - Xiao Zeng
- Guangzhou University of Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, 519015, Guangdong Province, China
| | - Qi-Jun Xie
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Jingle Road Number 53, XiangZhou District, ZhuHai City, 519015, Guangdong Province, China
| | - Hai-Yun Chen
- Guangzhou University of Chinese Medicine Second Affiliated Hospital (Guangdong Provincial Hospital of Chinese Medicine), Orthopedics Trauma Department Zhuhai Branch, Jingle Road Number 53, XiangZhou District, ZhuHai City, 519015, Guangdong Province, China
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Pinci MV, De Virgilio-Salgado L, Claudio-Marcano A, Salem-Hernandez J, Castañón-Pereira DL, Guzman H. Bilateral simultaneous tibial tubercle avulsion fractures in an adolescent baseball player: Case report and literature review. Int J Surg Case Rep 2023; 112:108986. [PMID: 37890236 PMCID: PMC10667898 DOI: 10.1016/j.ijscr.2023.108986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/11/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Fractures in the proximal tibial tuberosity are rare injuries. Even more uncommon are bilateral simultaneous fractures. Due to the few cases reported in the literature, we aimed to present a case which may contribute to the diagnosis and treatment of bilateral simultaneous tibial tubercle fractures. CASE PRESENTATION A 13-year-old Hispanic male presented to the emergency department after experiencing sudden knee buckling while running after standing up from the catcher's position (squatted) during a baseball game, causing him to collapse to the ground. Plain radiographs revealed displaced tibial tubercle avulsion fractures in both knees. He underwent bilateral open reduction and internal fixation. Fracture healing was completed without complications. DISCUSSION To the best of our knowledge, this is the first documented case of a Hispanic pediatric baseball player, adding to the small number of reported cases of bilateral tibial tubercle fractures. The presented case is rare in terms of the mechanism of injury, which has been scantly reported in the literature. CONCLUSION Due to the rarity of atraumatic bilateral tibial tubercle fractures we believe this documentation may be of clinical relevance.
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Affiliation(s)
- Marcantonio V Pinci
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Lucas De Virgilio-Salgado
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Alexandra Claudio-Marcano
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
| | - Joseph Salem-Hernandez
- University of Puerto Rico School of Medicine, University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico
| | | | - Humberto Guzman
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Lin B, Twaij H, Monem M, Sarraf KM. Proximal tibia triplane fracture with apophyseal avulsion. BMJ Case Rep 2023; 16:e254042. [PMID: 37491124 PMCID: PMC10373666 DOI: 10.1136/bcr-2022-254042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Tibial tuberosity fractures occur in fewer than 1% of all paediatric fractures. We present this unusual case of an early adolescent football player who presented to the emergency department after sustaining an injury during a tackle. CT confirmed a tibial apophyseal fracture concurrent with a proximal tibial triplane fracture. The fracture was subsequently reduced operatively with cancellous cannulated screws. There are only 11 cases published in the literature of triplane fractures of the proximal tibia. Both other cases that involve a concurrent tibial tuberosity fracture with a triplane extension were sustained following a footballing injury. We therefore propose that forced knee flexion alongside a rotational component, common to football, may promote this rare fracture pattern. It is hoped that this case can be used to shed light on a possible mechanism and to guide future management.
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Affiliation(s)
- Benjamin Lin
- Trauma & Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Haider Twaij
- Trauma & Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mohammed Monem
- Trauma & Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Khaled M Sarraf
- Trauma & Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Okamura H, Ishikawa H, Ohno T, Fujita S, Nagasaki K, Inagaki K, Kudo Y. Type V Tibial Tubercle Avulsion Fracture with Suspected Complication of Anterior Cruciate Ligament Injury: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1061. [PMID: 37374265 DOI: 10.3390/medicina59061061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Type V tibial tubercle avulsion fractures are extremely rare; therefore, information on them remains limited. Furthermore, although these fractures are intra-articular, to the best of our knowledge, there are no reports on their assessment via magnetic resonance imaging (MRI) or arthroscopy. Accordingly, this is the first report to describe the case of a patient undergoing detailed evaluation via MRI and arthroscopy. Case Presentation: A 13-year-old male adolescent athlete jumped while playing basketball, experienced discomfort and pain at the front of his knee, and fell down. He was transported to the emergency room by ambulance after he was unable to walk. The radiographic examination revealed a Type Ⅴ tibial tubercle avulsion fracture that was displaced. In addition, an MRI scan revealed a fracture line extending to the attachment of the anterior cruciate ligament (ACL); moreover, high MRI intensity and swelling due to ACL were observed, suggesting an ACL injury. On day 4 of the injury, open reduction and internal fixation were performed. Furthermore, 4 months after surgery, bone fusion was confirmed, and metal removal was performed. Simultaneously, an MRI scan obtained at the time of injury revealed findings suggestive of ACL injury; therefore, an arthroscopy was performed. Notably, no parenchymal ACL injury was observed, and the meniscus was intact. The patient returned to sports 6 months postoperatively. Conclusion: Type V tibial tubercle avulsion fractures are known to be extremely rare. Based on our report, we suggest that MRI should be performed without hesitation if intra-articular injury is suspected.
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Affiliation(s)
- Hiroki Okamura
- Department of Orthopedic Surgery, Nihon Koukan Hospital, 1-2-1 Koukandori, Kawasaki 210-0852, Japan
| | - Hiroki Ishikawa
- Department of Orthopedic Surgery, Nihon Koukan Hospital, 1-2-1 Koukandori, Kawasaki 210-0852, Japan
| | - Takuya Ohno
- Department of Orthopedic Surgery, Nihon Koukan Hospital, 1-2-1 Koukandori, Kawasaki 210-0852, Japan
| | - Shogo Fujita
- Department of Orthopedic Surgery, Nihon Koukan Hospital, 1-2-1 Koukandori, Kawasaki 210-0852, Japan
| | - Kei Nagasaki
- Department of Orthopedic Surgery, Nihon Koukan Hospital, 1-2-1 Koukandori, Kawasaki 210-0852, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Englert EG, Waheed M, Saleh E. A Tibial Tubercle Fracture Masquerading as an Inferior Pole of the Patella Fracture. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202301000-00011. [PMID: 36662798 PMCID: PMC9870223 DOI: 10.5435/jaaosglobal-d-22-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 12/04/2022] [Indexed: 01/21/2023]
Abstract
Pediatric tibial tubercle fractures are uncommon injuries that most often occur in adolescent men. Patients will typically present with anterior knee pain with or without patella alta. This case report describes a tibial tubercle fracture in a 13-year-old man misidentified as an inferior pole patella sleeve fracture on physical examination and preoperative radiographs. The tubercle reduction was secured with cannulated screws while injury to the patellar tendon periosteal sleeve was repaired with suture anchors. This case highlights the utility of advanced imaging when the etiology of extensor mechanism disruption is unclear. Furthermore, it is imperative to set expectations with parents and guardians that the full extent of the injury may only be confirmed under direct visualization in the operating room because of the complexity of such injuries.
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Affiliation(s)
- E Graham Englert
- From the Beaumont Health Royal Oak, Royal Oak, MI (Dr. Englert and Dr. Saleh), and Oakland University School of Medicine, Rochester, MI (Dr. Waheed)
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Lima AS, Cabral J, Boavida J, Balacó I, Sá Cardoso P, Tarquini O, Ling TP, Alves C. Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life. J Pediatr Orthop B 2022; 31:e135-e140. [PMID: 34380989 DOI: 10.1097/bpb.0000000000000905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of the study was to assess functional outcomes and quality of life of patients treated for tibial tubercle avulsion fractures (TTAFs). Retrospective study of patients under 18 years of age treated from June 2011 to May 2018. Demographic data included age, gender, mechanism of injury, side, fracture classification, associated injuries, predisposing factors, and type of treatment. Clinical results included knee range of motion, pain, return to sports, overall satisfaction, functional outcomes, and complications. At final follow-up, Tegner Lysholm Knee Scoring Scale, and Kidscreen-10 were applied. Ten patients were included, all males, with a median age of 15 years. Mechanism of injury: football (three patients), basketball (two patients), running (two patients), handball (one patient), gymnastics (one patient), and fall (one patient). Nine were treated surgically with reduction and fixation with cannulated screws or Kirschner wires, plus treatment of associated injuries (three patellar tendon avulsions, one contralateral proximal tibia epiphyseal fracture, and two prophylactic fasciotomies). One patient developed mild recurvatum and two presented minor decreased knee flexion. Eight patients returned to their previous level of sports activity. Median Tegner Lysholm Knee Score was 100/100 and Kidscreen-10 was 50/50. With appropriate treatment, nearly 100% of TTAFs have good functional outcomes and low impact on quality of life.
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Affiliation(s)
- Ana S Lima
- Department of Pediatric Orthopaedics, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra, EPE, Coimbra, Portugal
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Pedrazzini A, Maserati I, Cesaro G, Visigalli A, Casalini D, Bertoni N, Yewo SH, Pogliacomi F. Tibial tubercle avulsion fracture during sport activities in adolescent: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021571. [PMID: 35604251 PMCID: PMC9437667 DOI: 10.23750/abm.v92is3.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM OF WORK Tibial tubercle avulsion fractures (TTAF) are uncommon condition in children and adolescents. These lesions may be misdiagnosed and consequently not properly treated. Reduction and fixation is indicated if displacement is higher than 2mm or if the extensor apparatus is damaged. Authors present a case of a TTAF associated with a complete lateral patellar retinaculum lesion in a 13-year-old male adolescent non-professional basketball player. METHODS Surgery consisted of reduction and fixation with 2 half threaded cancellous and washers; TTA was then basted and reinforced with a non absorbable suture according to Krachow technique and finally the patellar lateral retinaculum through a direct repair with absorbable material. RESULTS Clinical evaluation after 3 years showed bone healing, a complete resolution of pain, complete range of motion, good strength and complete functionality of the operated limb. CONCLUSIONS Misdiagnosis or delayed treatment of TTAF can often result in nonunion, functional impairment, and persistent pain. For these reasons, authors believe that a stable and quick fixation associated to specialized rehabilitation are crucial for recovery. (www.actabiomedica.it).
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Affiliation(s)
- Alessio Pedrazzini
- Orthopaedic Unit, Oglio Po Hospital, Vicomoscano (CR), ASST Cremona, Cremona, Italy
| | - Ilaria Maserati
- Orthopaedic and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Cesaro
- Orthopaedic and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alberto Visigalli
- Orthopaedic and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Daniele Casalini
- Orthopaedic Unit, Oglio Po Hospital, Vicomoscano (CR), ASST Cremona, Cremona, Italy
| | - Nicola Bertoni
- Orthopaedic Unit, Oglio Po Hospital, Vicomoscano (CR), ASST Cremona, Cremona, Italy
| | - Simon Henry Yewo
- Orthopaedic Unit, Oglio Po Hospital, Vicomoscano (CR), ASST Cremona, Cremona, Italy
| | - Francesco Pogliacomi
- Orthopaedic and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
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