Abstract
Background Tibial tubercle avulsion fractures are rare, they represent less than 1% of all physeal
fractures. Compared to monolateral tibial tubercle avulsion fractures, bilateral occurrence
is even rarer. The purpose of this study is to report about the so far largest group
of bilateral avulsion fractures and to compare them to unilateral fractures as well
as to current literature.
Method All patients who suffered from bilateral tibial tubercle fractures between January
2009 and March 2019 were included. All medical records and radiographs were reviewed
and a clinical follow-up was performed. The examined criteria were age, gender, mechanism
of injury, classification, risk factors, complications, management and outcomes. Clinical
outcome was measured using the well established Tegner activity scale and Lysholm-Gillquist
score. The same criteria were analyzed in a literature review of bilateral tibial
tubercle fractures to compare our results to available literature.
Results We found four children with bilateral tibial tubercle avulsion fractures. All patients
were male with a mean age of 14.5 ± 0.7 years (13 – 15). Mean follow-up examination
was 13.6 ± 6.5 months (8 – 29) after surgery. The avulsions occurred during jumping
activities in all cases. All children could no longer stand or move because of sudden
pain in the knee. We found type IV fractures in three cases, type III fractures in
four cases and one type V fracture according to the Ogden classification. All children
were treated by open or closed reduction and stabilization with screws or K-wires.
Follow-up showed complete fracture healing without complications in all patients.
There were no changes in Tegner activity scale and Lysholm-Gillquist Score and knee
function comparable to prior to the accident was achieved in all cases.
Conclusion Good clinical results without restrictions regarding function of the knee joint can
be achieved by direct operative treatment of bilateral tibial avulsion fractures.
A reduction in sporting activity has not to be expected. There were no differences
between bilateral or unilateral tibial tubercle avulsion fractures.
Key words
tibial tubercle fracture - avulsion - children - Ogden classification
