Tibial Tubercle Fracture Treatment & Management

  • Author: Kelvin Lau, BM, BCh, MA, MRCS, DPhil; Chief Editor: Carlos J Lavernia, MD, FAAOS   more...
 
Updated: Feb 10, 2012
 

Medical Therapy

Medical therapy typically involves analgesia for pain control and thromboprophylaxis. The patient's discomfort can be controlled with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). If the pain continues, a narcotic analgesic can be added.

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Surgical Therapy

Type IA injuries are treated conservatively with cast immobilization in full extension, followed by gradual rehabilitation of the quadriceps. Type IB, type II, and type III injuries are treated with open reduction and internal fixation.[9] Type III injuries may also require exploration of the knee joint for meniscal and ligamentous damage, with accurate reduction of the intra-articular surface.

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Preoperative Details

The surgical procedure is determined by type of fracture. The preoperative assessment is designed to identify the fracture, its displacement, and any associated injuries.

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Intraoperative Details

Open reduction and internal fixation is the treatment of choice. The fracture is approached from an anterior or lateral parapatellar incision. Interposed soft tissue is cleared to promote accurate reduction. The tibial tuberosity is reduced and fixed to the tibia by using 1 or 2 screws.

Arthroscopy or arthrotomy may be required to repair damaged menisci and to refashion a smooth articular surface, particularly in type III injuries.

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Postoperative Details

Analgesia is required for control of postoperative pain.

Physiotherapy is also part of the patients' postoperative care. Progressive rehabilitation of the quadriceps is required after cast immobilization. Physiotherapy and progressive weightbearing exercises can be performed soon after open reduction and internal fixation is completed. Early mobilization attenuates joint stiffness and weakness due to prolonged immobilization.

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Follow-up

An orthopedic surgeon should follow-up patients to ensure the fracture is healing correctly and that any complications are managed.

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Complications

Complications are rare and include those related to trauma (eg, thromboembolism) or effects specific to the fracture. The latter includes meniscal damage in type III injuries, bursitis over metalwork, malunion, nonunion, recurrence, early degenerative change, genu recurvatum, and leg-length discrepancy.

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Outcome and Prognosis

The prognosis is excellent, and most patients recover full function within a year.

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Contributor Information and Disclosures
Author

Kelvin Lau, BM, BCh, MA, MRCS, DPhil  Specialist Registrar in Cardiothoracic Surgery, Trent Deanery, UK

Kelvin Lau, BM, BCh, MA, MRCS, DPhil is a member of the following medical societies: Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Coauthor(s)

Manoj Ramachandran, MBBS, MRCS, FRCS  Consultant Trauma and Orthopaedic Surgeon, Barts and the London NHS Trust; Honorary Senior Lecturer, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary's, University of London, UK

Manoj Ramachandran, MBBS, MRCS, FRCS is a member of the following medical societies: British Orthopaedic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert D Bronstein, MD  Associate Professor, Department of Orthopedics, Division of Athletic Medicine, University of Rochester School of Medicine

Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas M DeBerardino, MD  Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS  Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital

Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society

Disclosure: Zimmer Stock Implant Designer

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Dr Fergal Monsell to the development and writing of this article.

References

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  12. Nimityongskul P, Montague WL, Anderson LD. Avulsion fracture of the tibial tuberosity in late adolescence. J Trauma. Apr 1988;28(4):505-9. [Medline].

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  14. Zionts LE. Fractures around the knee in children. J Am Acad Orthop Surg. Sep-Oct 2002;10(5):345-55. [Medline].

 
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