Management of avulsion fracture of proximal tibial tubercle in adolescents with a particular reference to the complications

DU Xiang-ping; ZHANG Zi-ming; ZHAO Li; CHEN Qiu; DING Jing

doi:10.3969/j.issn.2095-252X.2013.07.007

Abstract： Objective To report the results of the management of avulsion fracture of proximal tibial tubercle, with a particular reference to the prognosis and complications in adolescents. Methods 18 patients ( all boys ) with tibial tuberosity fracture were included in the present series. The mean age of patients was 14.3 years old, ranging from 12.8 to 17.1 years. 11 fractures were involved at the left side while 7 at the right side. All were unilateral fractures. According to the modified system of Ogden classification, there were 1 type I A, 2 type II A, 2 type II B, 4 type III A, 6 type III B, 3 type IV B and 1 type V B fractures. 6 cases were treated with closed reduction and immobilization with plaster cast, but refracture occurred in one of the cases, which was then treated surgically. The total 13 patients were operated upon with open reduction and internal fixation. SPSS18.0 software package was used for statistical analysis with chi-square test, comparing the complication rates of type I-III and type IV-V fractures. Results 18 patients were followed up for an average of 13 months ( range;6-36 months ). The mean healing time of the fracture was 12 weeks ( range;8-20 weeks ). According to the assessment system described by Mosier and Stanitski, the knee joint function was excellent in all cases. 2 patients of type IV-V fractures, who were performed with plaster external fixation, had complications, whereas none occurred in those of type I-III fracture ( P<0.05 ). Conclusions Open reduction and internal fixation should be recommended for the management of the facture with remarkable displacement, comminution or the facture involving the articular surface. The treatment with hollow lag screw fixation could achieve good results.