Tibial Tubercle Fracture Treatment & Management

Updated: Oct 24, 2018
  • Author: Kelvin Lau, BM, BCh, MA, MRCS, DPhil, FRCS(CTh); Chief Editor: Thomas M DeBerardino, MD  more...
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Treatment

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

The surgical procedure is determined by the type of fracture. [15, 16] The preoperative assessment is designed to identify the fracture, its displacement, and any associated injuries.

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 (ORIF). [17] Type III injuries may also require exploration of the knee joint for meniscal and ligamentous damage, with accurate reduction of the intra-articular surface.

In ORIF, 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 one or two screws. [18] 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 Care

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 ORIF is completed. Early mobilization attenuates joint stiffness and weakness due to prolonged immobilization.

The prognosis is excellent, and most patients recover full function within 1 year. An orthopedic surgeon should follow patients to ensure that 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.

Frey et al retrospectively reviewed 20 tibial tuberosity fractures in 19 adolescents (mean age, 13.7 years; range, 10-19 years) for fracture morphology, mechanism of injury, fracture management, and complications. [19] There were nine left-side injuries and 11 right-side injuries; one patient had bilateral fractures. Injury mechanisms included basketball (n = 8), running (n = 5), football (n = 3), fall from a scooter (n = 2), high-jumping (n = 1), and fall (n = 1). Comorbidities included Osgood-Schlatter disease (n = 3) and osteogenesis imperfecta (n = 1).

All 19 patients were treated with ORIF, including arthroscopic procedures in two cases. [19] Complications included preoperative presentation of compartment syndrome (n = 4, all requiring fasciotomy), postoperative stiffness (n = 1), and painful hardware that required removal (n = 1). Range of motion was started an average of 4.3 weeks postoperatively, and return to play was an average of 3.9 months postoperatively.

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