Tibial tubercle avulsion fractures in children

Area of Science:

• Orthopedic surgery
• Pediatric sports medicine
• Pediatric orthopedics

Background:

• Pediatric tibial tubercle avulsion fractures (TTAFs) are uncommon, representing less than 1% of pediatric physeal injuries.
• The incidence of TTAFs is rising, associated with increased participation in high-level athletics among adolescents.

Purpose of the Study:

• To review the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs).
• To discuss imaging, classification, associated injuries, treatment, outcomes, and complications.
• To provide an overview for clinicians managing these injuries.

Main Methods:

• Literature review of pediatric tibial tubercle avulsion fractures.
• Discussion of imaging modalities and classification systems (e.g., Ogden).
• Analysis of treatment options (nonsurgical vs. surgical) and their indications.

Main Results:

• TTAFs typically affect adolescents nearing skeletal maturity involved in jumping sports.
• Ogden's classification system is commonly used for categorizing TTAFs.
• Surgical repair, including open reduction and internal fixation (ORIF) and arthroscopy, is frequently indicated.
• Arthroscopy aids in identifying associated soft tissue injuries and confirming reduction.
• Hardware irritation is the most common postoperative complication.

Conclusions:

• Both nonsurgical and surgical management of TTAFs lead to excellent outcomes.
• High rates of fracture union and successful return to sports are achievable with appropriate treatment.
• Understanding fracture patterns and associated injuries is crucial for optimal patient management.