Figure - available from: Case Reports in Orthopedics
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Clinical photograph shows bilateral anterior knee swelling. Bilateral lateral knee radiographs demonstrate the flecks of bone and high-riding patella. Patellar tendon soft tissue shadow shows the waviness of the tendon indicating loss of its integrity.
Source publication
Tibial tubercle sleeve fracture is a rare injury. In concept, it is similar to the patellar sleeve fracture in a skeletally immature patient. We describe a unique case of simultaneous bilateral tibial tubercle sleeve fractures in a 12-year-old boy. Radiographs and MRI confirmed the injury. The patient underwent open surgical repair of bilateral sle...
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Citations
... The quadriceps undergoes an eccentric load avulsing the patellar tendon complex. Failure of the patellar tendon is relatively uncommon among extensor mechanism injuries of the knee [1,5]. Zernicke et al. [6] reported that a load of 17.5 times the body weight is required to rupture the human patellar tendon. ...
... Whereas the distinguishing between patella tendon rupture and avulsion fracture was difficult in the present case because the fleck of bone was tiny and the displacement was minimal. Desai and Parikh [5] reported that a high-riding patella, palpable gap at the site of the patellar tendon, and an inability to perform active extension are important findings suggestive of patellar tendon injuries. Although physical examination is important, such examination is difficult to perform because of the swelling and pain around the knee in pediatric patients. ...
Rupture of the patellar tendon is relatively rare. We report a case of patellar tendon avulsion with a tibial tuberosity sleeve fragment in pediatric patient. In pediatric patient, diagnosis is sometimes difficult due to uncompleted ossification. In the present case, which involved the presence of a small fleck of bone from tibia, we were able to attain a diagnosis using the Koshino-Sugimoto index and MRI and easily determine the optimal treatment with the use of the suture anchor and tension band wiring method.
... 3% of all epiphyseal and 1% of all physeal injuries in adolescents [1][2][3][4]. Bilateral injuries are very rare, with only 19 cases described in the literature [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. In 1955, Borsch-Madsen [23] reported the first case of simultaneous bilateral avulsion fractures of the tibial tubercle. ...
Tibial tuberosity avulsion fractures are injuries accounting for less than 3% of all epiphyseal and 1% of all physeal injuries in adolescents. Bilateral injuries are very rare, with only 19 cases described in the literature. These types of fractures occur commonly in male teenagers during sport activities and are often associated with other orthopaedic disorders. We report the case of a male teenager with simultaneous bilateral tibial tubercle fractures, describe the evolution and treatment of this injury and review the literature on this subject.
Level of evidence:
Case report.
... In 2002 Davidson first described and unusual injury pattern whereby a tendon is avulsed from the bone with a sleeve of cartilage or periosteum with or without osseous fragments (1). This can also occur from the inferior pole of the patella and this pattern of injury has been described (2)(3)(4)(5)(6). Patella tendon sleeve fractures often have subtle radiographic findings. ...
... Rupture in these individuals however remains low. Unlike the other case of tibial tuberosity avulsion fractures (1,3,6) in this case the MRI scan confirmed severe patellar tendinosis affecting the whole of the patellar tendon. Repetitive microtrauma may well have been a predisposing factor in this case. ...
Introduction:
A sleeve fracture classically describes an avulsion of cartilage or periosteum with or without osseous fragments and usually occurs at the inferior margin of the patella. Tibial tubercle sleeve fractures in the skeletally immature are extremely rare.
Case presentation:
In this report the authors describe a 12-year-old boy with no systemic disease and no steroid use who sustained bilateral proximal tibial sleeve fractures whilst playing football. Both ruptures were associated with rupture of the medial patellofemoral ligament and tear of the medial retinaculum. Treatment was performed with primary end-to-end repair, reinforcement with bone anchors and cerclage wires with an excellent outcome.
Conclusions:
We feel this rare, currently unclassified variant of a tibial tubercle avulsion fracture should be recognised and consideration taken to adding it to existing classification systems.
Fractures of the proximal tibial epiphysis are rare, representing less than 3% of all epiphyseal and 1% of all physeal injuries in adolescents. Bilateral injuries are extremely rare. The specific anatomical and histological features of the proximal tibial epiphysis make it vulnerable to a specific fracture pattern that occurs when the tensile force of the quadriceps is greater than the fibrocartilaginous tissue underlying the tibial tuberosity. We report the first case to our knowledge of a 12-year-old boy who sustained simultaneous bilateral tibial avulsion fractures on the background of a previous conservatively managed unilateral tibial tuberosity avulsion fracture. We report this case for its uniqueness and as an educational review of the anatomy, the mechanism of injury, and the development of classifying these fractures and discussion of the stages of the growing physis that determine the treatment approach.
While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently. A thorough understanding of the pertinent developmental anatomy is critical for correlating the clinical findings with the imaging work-up, and for anticipating the most common and the most serious complications of each fracture. Diagnosis is usually made with appropriate plain radiographs with advanced imaging often used for preoperative planning. In general, fracture pattern and degree of displacement determine the need for surgical intervention and the overall outcome. While a variety of fixation techniques or constructs may be used, because of the importance of restoring physeal and articular anatomy for avoidance of growth disturbance and degenerative joint disease, respectively, achieving anatomic, rigid fixation is of greater importance than with many other fracture locations in the growing skeleton.
