Tibial Tubercle Fracture Workup

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

Laboratory Studies

  • Laboratory studies are not indicated unless other diagnoses are being evaluated.
  • Preoperative investigations are requested as required.
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Imaging Studies

  • Radiography of the knee is the main imaging study.
    • Findings are diagnostic of the condition.
    • The tibial tubercle is imaged on a lateral radiograph with the leg in slight internal rotation.
    • Oblique views of the proximal tibia may help reveal the extent of the fracture.
    • Radiographs of the contralateral knee may show evidence of Osgood-Schlatter disease.
  • Other forms of imaging are not performed routinely, and they are requested as required if alternative diagnoses are being considered.
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Other Tests

  • Other tests are not indicated unless other diagnoses are being considered.
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Diagnostic Procedures

  • Lateral radiographs of the knee are useful in diagnosis.
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Staging

The fracture is classified into 6 subtypes to guide management. See Pathophysiology, above.

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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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  2. 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. Dec 2008;128(12):1437-42. [Medline].

  3. Hanley C, Roche SJ, Chhabra J. Acute simultaneous bilateral avulsion fractures of the tibial tubercles in a 15-year-old male hurler: case report and literature review. Ir J Med Sci. Dec 4 2008;[Medline].

  4. Frey S, Hosalkar H, Cameron DB, Heath A, David Horn B, Ganley TJ. Tibial tuberosity fractures in adolescents. J Child Orthop. Dec 2008;2(6):469-74. [Medline].

  5. Chakraverty JK, Weaver MJ, Smith RM, Vrahas MS. Surgical management of tibial tubercle fractures in association with tibial plateau fractures fixed by direct wiring to a locking plate. J Orthop Trauma. Mar 2009;23(3):221-5. [Medline].

  6. Cohen DA, Hinton RY. Bilateral tibial tubercle avulsion fractures associated with Osgood-Schlatter's disease. Am J Orthop. Feb 2008;37(2):92-3. [Medline].

  7. Watson-Jones R. Fractures and Joint Injuries. 6th ed. New York:. Churchill Livingstone;1982.

  8. Ogden JA, Tross RB, Murphy MJ. Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am. Mar 1980;62(2):205-15. [Medline].

  9. Pesl T, Havranek P. Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method. J Child Orthop. Oct 2008;2(5):353-6. [Medline].

  10. Buhari SA, Singh S, Wong HP, Low YP. Tibial tuberosity fractures in adolescents. Singapore Med J. Oct 1993;34(5):421-4. [Medline].

  11. Mirbey J, Besancenot J, Chambers RT, et al. Avulsion fractures of the tibial tuberosity in the adolescent athlete. Risk factors, mechanism of injury, and treatment. Am J Sports Med. Jul-Aug 1988;16(4):336-40. [Medline].

  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].

  13. Wiss DA, Schilz JL, Zionts L. Type III fractures of the tibial tubercle in adolescents. J Orthop Trauma. 1991;5(4):475-9. [Medline].

  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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Ossification centers and epiphyseal cartilages of the proximal tibia and tibial tuberosity.
Classification of tibial tuberosity fractures.
 
 
 
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