Following the epiphyseal stage is the final stage resulting in bony fusion which completes the formation process in females by age 15 and males by age 17 4. This stage occurs in females between the ages of 10 to 15 years old and in males from 11 to 17 years old 4. The epiphyseal stage follows with merging of the apophysis and the epiphysis of the proximal tibia. This stage begins in females between the ages of 8 to 12 years old and in males from 9 to 14 years old 4. The first stage is the cartilaginous stage which begins by the 15th week of gestation 7 and is succeeded by the apophyseal stage in which the tibial tubercle’s secondary ossification center becomes apparent. The tibial tubercle forms in four separate stages as described by Ehrenborg 4,5,6. The tibial tubercle is a bony prominence on the midline anterior tibia just inferior to where the anterior surfaces of the medial and lateral tibial condyles join. This injury pattern accounts for less than 1% of all pediatric fractures and is even less common in adult populations. Tibial tuberosity avulsion fractures are extremely rare fracture patterns, with reported incidence rates of 0.4% to 2.7% of all epiphyseal injuries, <1% of all physeal injuries, and about 3% of all proximal tibial injuries 1,2,3. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle.ĭiscussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern.Ĭase Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. Patel College of Osteopathic Medicine, Florida, USAĢDepartment of Orthopedic Surgery, Broward Health, Florida, USA Sharan 1, Derek Jones 2ġNova Southeastern University, Kiran C. Tibial Tubercle Avulsion Fractures in Adolescents: A Narrative Review & Case Report
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