Comminuted simultaneous bilateral tibial tubercle avulsion fractures: a case report

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Pediatric Orthopedics

Background:

• Tibial tubercle avulsion fractures are uncommon injuries, particularly when occurring bilaterally and simultaneously.
• These fractures involve the separation of the tibial tubercle from the tibia, often during forceful quadriceps contraction.
• Understanding the fracture patterns and associated intra-articular involvement is critical for successful treatment outcomes.

Observation:

• A 16-year-old male experienced simultaneous bilateral tibial tubercle avulsion fractures after a sudden deceleration during running.
• The left knee sustained a minimally displaced Type V fracture, treated conservatively with closed reduction and uneventful recovery.
• The right knee presented with a Type III fracture, characterized by severe intra-articular comminution posterior to a displaced tubercle fragment.

Findings:

• Surgical intervention (open reduction and internal fixation) was necessary for the right tibial tubercle fracture to address the displaced apophyseal and intra-articular fragments.
• The patient's recovery on the right was complicated by a severe, persistent flexion deformity, requiring manipulation under anesthesia and extensive rehabilitation.
• A residual 5-degree flexion deformity persisted 16 months post-injury, underscoring the challenges associated with complex intra-articular involvement.

Implications:

• This case emphasizes the critical importance of meticulously identifying and anatomically reducing all intra-articular fragments in tibial tubercle avulsion fractures.
• Aggressive post-operative mobilization and tailored rehabilitation strategies are essential to prevent complications like persistent flexion deformities.
• Optimal management requires a high index of suspicion for intra-articular extension and a comprehensive surgical and rehabilitative approach.