J Knee Surg 2018; 31(06): 490-497
DOI: 10.1055/s-0038-1625955
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Extensor Mechanism Injury in the Pediatric Population—A Clinical Review

William Cody Sessions
1   Department of Orthopedics, University of Minnesota, Minneapolis, Minnesota
,
Matthew Herring
1   Department of Orthopedics, University of Minnesota, Minneapolis, Minnesota
,
Walter H. Truong
2   Gillette Children's Specialty Healthcare, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations
Further Information

Publication History

09 December 2017

19 December 2017

Publication Date:
06 February 2018 (online)

Abstract

The extensor mechanism of the knee—consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament—is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.

Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuries on a regular basis. It is the intent of this article to discuss the current literature regarding the mechanism of injury, diagnostic workup, classification, indications for surgical versus non-surgical management, and techniques for operative management for both tibial tubercle and patella (transverse and sleeve) fractures.

 
  • References

  • 1 Ehrenborg G, Engfeldt B. The insertion of the ligamentum patellae on the tibial tuberosity. Some views in connection with the Osgood-Schlatter lesion. Acta Chir Scand 1961; 121: 491-499
  • 2 Ogden JA, Southwick WO. Osgood-Schlatter's disease and tibial tuberosity development. Clin Orthop Relat Res 1976; (116) 180-189
  • 3 McKoy BE, Stanitski CL. Acute tibial tubercle avulsion fractures. Orthop Clin North Am 2003; 34 (03) 397-403
  • 4 Mosier SM, Stanitski CL. Acute tibial tubercle avulsion fractures. J Pediatr Orthop 2004; 24 (02) 181-184
  • 5 Zrig M, Annabi H, Ammari T, Trabelsi M, Mbarek M, Ben Hassine H. Acute tibial tubercle avulsion fractures in the sporting adolescent. Arch Orthop Trauma Surg 2008; 128 (12) 1437-1442
  • 6 Bolesta MJ, Fitch RD. Tibial tubercle avulsions. J Pediatr Orthop 1986; 6 (02) 186-192
  • 7 Chow SP, Lam JJ, Leong JC. Fracture of the tibial tubercle in the adolescent. J Bone Joint Surg Br 1990; 72 (02) 231-234
  • 8 Frey S, Hosalkar H, Cameron DB, Heath A, David Horn B, Ganley TJ. Tibial tuberosity fractures in adolescents. J Child Orthop 2008; 2 (06) 469-474
  • 9 Hand WL, Hand CR, Dunn AW. Avulsion fractures of the tibial tubercle. J Bone Joint Surg Am 1971; 53 (08) 1579-1583
  • 10 Shelton WR, Canale ST. Fractures of the tibia through the proximal tibial epiphyseal cartilage. J Bone Joint Surg Am 1979; 61 (02) 167-173
  • 11 Brey JM, Conoley J, Canale ST. , et al. Tibial tuberosity fractures in adolescents: is a posterior metaphyseal fracture component a predictor of complications?. J Pediatr Orthop 2012; 32 (06) 561-566
  • 12 Levi JH, Coleman CR. Fracture of the tibial tubercle. Am J Sports Med 1976; 4 (06) 254-263
  • 13 Pretell-Mazzini J, Kelly DM, Sawyer JR. , et al. Outcomes and Complications of Tibial Tubercle Fractures in Pediatric Patients: A Systematic Review of the Literature. J Pediatr Orthop 2016; 36 (05) 440-446
  • 14 Watson-Jones R. The classic: “Fractures and Joint Injuries” by Sir Reginald Watson-Jones, taken from “Fractures and Joint Injuries,” by R. Watson-Jones, Vol. II, 4th ed., Baltimore, Williams and Wilkins Company, 1955. Clin Orthop Relat Res 1974; (105) 4-10
  • 15 Pace JL, McCulloch PC, Momoh EO, Nasreddine AY, Kocher MS. Operatively treated type IV tibial tubercle apophyseal fractures. J Pediatr Orthop 2013; 33 (08) 791-796
  • 16 Ryu RK, Debenham JO. An unusual avulsion fracture of the proximal tibial epiphysis. Case report and proposed addition to the Watson-Jones classification. Clin Orthop Relat Res 1985; (194) 181-184
  • 17 Frankl U, Wasilewski SA, Healy WL. Avulsion fracture of the tibial tubercle with avulsion of the patellar ligament. Report of two cases. J Bone Joint Surg Am 1990; 72 (09) 1411-1413
  • 18 Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop 2012; 32 (08) 749-759
  • 19 Howarth WR, Gottschalk HP, Hosalkar HS. Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease. J Child Orthop 2011; 5 (06) 465-470
  • 20 Deliyannis SN. Avulsion of the tibial tuberosity: report of two cases. Injury 1973; 4 (04) 341-344
  • 21 Christie MJ, Dvonch VM. Tibial tuberosity avulsion fracture in adolescents. J Pediatr Orthop 1981; 1 (04) 391-394
  • 22 Henard DC, Bobo RT. Avulsion fractures of the tibial tubercle in adolescents. A report of bilateral fractures and a review of the literature. Clin Orthop Relat Res 1983; (177) 182-187
  • 23 Hamilton SW, Gibson PH. Simultaneous bilateral avulsion fractures of the tibial tuberosity in adolescence: a case report and review of over 50 years of literature. Knee 2006; 13 (05) 404-407
  • 24 Pesl T, Havranek P. Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method. J Child Orthop 2008; 2 (05) 353-356
  • 25 Little RM, Milewski MD. Physeal fractures about the knee. Curr Rev Musculoskelet Med 2016; 9 (04) 478-486
  • 26 Clarke DO, Franklin SA, Wright DE. Avulsion fracture of the tibial tubercle associated with patellar tendon avulsion. Orthopedics 2016; 39 (03) e561-e564
  • 27 Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc 1999; 7 (04) 243-245
  • 28 Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 1992; 32 (04) 464-467
  • 29 Beaty JH, Kumar A. Fractures about the knee in children. J Bone Joint Surg Am 1994; 76 (12) 1870-1880
  • 30 Gao GX, Mahadev A, Lee EH. Sleeve fracture of the patella in children. J Orthop Surg (Hong Kong) 2008; 16 (01) 43-46
  • 31 Maguire JK, Canale ST. Fractures of the patella in children and adolescents. J Pediatr Orthop 1993; 13 (05) 567-571
  • 32 Hunt DM, Somashekar N. A review of sleeve fractures of the patella in children. Knee 2005; 12 (01) 3-7
  • 33 Schmal H, Strohm PC, Niemeyer P, Reising K, Kuminack K, Sudkamp NP. Fractures of the patella in children and adolescents. Acta Orthop Belg 2010; 76 (05) 644-650
  • 34 Zionts LE. Fractures around the knee in children. J Am Acad Orthop Surg 2002; 10 (05) 345-355
  • 35 Bruijn JD, Sanders RJ, Jansen BR. Ossification in the patellar tendon and patella alta following sports injuries in children. Complications of sleeve fractures after conservative treatment. Arch Orthop Trauma Surg 1993; 112 (03) 157-158
  • 36 Guy SP, Marciniak JL, Tulwa N, Cohen A. Bilateral sleeve fracture of the inferior poles of the patella in a healthy child: case report and review of the literature. Adv Orthop 2011; 2011: 428614
  • 37 Green NE, Rogers RA, Lipscomb AB. Nonunions of stress fractures of the tibia. Am J Sports Med 1985; 13 (03) 171-176
  • 38 Heckman JD, Alkire CC. Distal patellar pole fractures. A proposed common mechanism of injury. Am J Sports Med 1984; 12 (06) 424-428
  • 39 Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. Am J Sports Med 1991; 19 (05) 525-528
  • 40 Grogan DP, Carey TP, Leffers D, Ogden JA. Avulsion fractures of the patella. J Pediatr Orthop 1990; 10 (06) 721-730
  • 41 Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 1979; 61-B (02) 165-168
  • 42 Wessel LM, Scholz S, Rüsch M. Characteristic pattern and management of intra-articular knee lesions in different pediatric age groups. J Pediatr Orthop 2001; 21 (01) 14-19
  • 43 Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994; 193 (03) 825-827
  • 44 Shands PA, McQueen DA. Demonstration of avulsion fracture of the inferior pole of the patella by magnetic resonance imaging. A case report. J Bone Joint Surg Am 1995; 77 (11) 1721-1723
  • 45 Belman DA, Neviaser RJ. Transverse fracture of the patella in a child. J Trauma 1973; 13 (10) 917-918
  • 46 Damrow DS, Van Valin SE. Patellar sleeve fracture with ossification of the patellar tendon. Orthopedics 2017; 40 (02) e357-e359
  • 47 Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl 1972; 143: 1-80
  • 48 Crawford AH. Fractures about the knee in children. Orthop Clin North Am 1976; 7 (03) 639-656
  • 49 Weber MJ, Janecki CJ, McLeod P, Nelson CL, Thompson JA. Efficacy of various forms of fixation of transverse fractures of the patella. J Bone Joint Surg Am 1980; 62 (02) 215-220
  • 50 Edwards B, Johnell O, Redlund-Johnell I. Patellar fractures. A 30-year follow-up. Acta Orthop Scand 1989; 60 (06) 712-714
  • 51 Makhdoomi KR, Doyle J, Moloney M. Transverse fracture of the patella in children. Arch Orthop Trauma Surg 1993; 112 (06) 302-303
  • 52 Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. Berlin: Springer; 1991: 553-594
  • 53 Kaar TK, Murray P, Cashman WF. Transosseous suturing for sleeve fracture of the patella: case report. Ir J Med Sci 1993; 162 (04) 148-149
  • 54 Hung LK, Lee SY, Leung KS, Chan KM, Nicholl LA. Partial patellectomy for patellar fracture: tension band wiring and early mobilization. J Orthop Trauma 1993; 7 (03) 252-260
  • 55 Kastelec M, Veselko M. Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. J Bone Joint Surg Am 2004; 86-A (04) 696-701