A case of an avulsion of the tibial tubercle in a child is presented. The treatment involved open reduction with internal fixation using a screw. The post-operative period was uneventful, and the fracture healed in eight weeks.
A 14-year-old male sustained a twisting injury to his right knee while playing football. He presented to the A & E with a painful swollen knee. On examination, it was found that the boy had a grade 3 effusion in the lower half of his knee. The knee was held in flexion, and there was no distal neurovascular deficit. Plain radiographs that were taken showed a type 3 avulsion fracture of the tibial tubercle according to the Ogden et al. classification. The boy was treated by open reduction and internal fixation using a 5 mm cannulated cancellous screw and the torn periosteum was repaired using the midline infrapatellar approach. There was no associated meniscal or ligament injury. Post-operatively, the knee was immobilized in extension using a posterior knee splint for six weeks. Static quadriceps and foot movements were encouraged during this period. The patient was advised to remain in a non-weight-bearing state for six weeks. The splint was discarded thereafter and knee range of motion exercises were given. The fracture united in eight weeks. The patient was advised to avoid sports for six months from the time the injury had occurred. The patient recovered uneventfully.
Acute traumatic avulsions of the tibial tubercle occur most often during sports. An injury results when the pull of the patellar ligament exceeds the combined strength of the growth plate underlying the tubercle, the surrounding perichondrium and the adjacent periosteum. The avulsion of the tubercle can result from a sudden acceleration or decceleration of the knee extensor mechanism. Ogden et al. have classified physeal injuries into nine types. Avulsion of the tibial tubercle is classified as a Type 3 fracture and is analogous to the fracture of Tillaux at the ankle because the posterior portion of the physis of the proximal tibia closes. Minimally displaced small avulsion fragments can be treated non-operatively using a cast in extension. Larger displaced fragments require open reduction internal fixation using transfixing pins or screws. Post-operatively, a cast or a brace in extension is continued for six weeks and the patient is advised to do the knee range of motion exercises thereafter. These fractures, if treated correctly, heal uneventfully. Blount has reported genu recurvatum as being a significant complication of this injury in an immature child. Patients usually return to sports a year after their injury had occurred.
Acute traumatic avulsion of the tibial tubercle.
Based on the provided anteroposterior and lateral X-ray images of the knee joint, a lesion is noted at the proximal tibial tubercle. The region of the tubercle appears separate from the main bone structure, showing a clear fracture line. Postoperative imaging indicates a screw fixation at the tibial tubercle in a satisfactory position, with good reduction and alignment of the fracture. No obvious large fluid collection or disorganized bone trabeculae is visible in the surrounding soft tissue. The joint space does not show significant narrowing or widening. Overall, the postoperative fracture alignment appears favorable.
Considering the patient’s sex, age (14 years old, growth plates not fully closed), history of sports-related trauma, and both preoperative and postoperative imaging findings: a Tibial Tubercle Avulsion Fracture (Type 3 by the Ogden classification) is most consistent with the clinical and radiological presentation. The patient has undergone screw fixation surgery, fitting standard treatment protocols.
The principle of rehabilitation is a gradual, individualized approach to training intensity and load, ensuring safe healing of the injured area.
During rehabilitation, consider the patient’s age and ongoing skeletal growth. Adjust exercise intensity and methods in a timely manner to avoid reinjury. If excessive pain, joint effusion, or other discomfort occurs, seek medical evaluation promptly and revise the rehabilitation plan accordingly.
This report is a reference-based medical analysis derived from the provided data and does not substitute for in-person consultation or a professional physician’s assessment. For specific diagnoses and treatment plans, please consult an orthopedic or sports medicine specialist.
Acute traumatic avulsion of the tibial tubercle.
