Tibial tubercle avulsion fractures in children and adolescents

Tibial tubercle avulsion fractures (TTAFs) are uncommon injuries in the pediatric population, predominantly affecting children and adolescents who are approaching skeletal maturity and frequently engage in high-energy activities. Despite of their rarity, TTAFs can significantly impact the lives of young individuals involved in sports and other strenuous activities. The mechanism of TTAFs occurrence involves forceful quadriceps contraction against resistance or rapid knee flexion with contracted quadriceps. TTAFs may coincide with other related injuries due to their mechanism of occurrence and commonly present with an abrupt onset of pain, focal soft-tissue swelling and tenderness on palpation. Predisposing factors such as a history of Osgood-Schlatter disease and an extreme body mass index (BMI) could contribute to TTAFs susceptibility. Diagnosis of TTAFs typically relies on X-rays, complemented by computed tomography (CT) and magnetic resonance imaging (MRI) for screening associated injuries and preoperative assessment. While a well-established classification system exists, with the Ogden classification being the most commonly employed, intriguingly, a direct correlation between fracture type and treatment method, as well as the choice of surgical fixation modality, remains elusive. The management of TTAFs encompasses both conservative and surgical approaches, with open reduction internal fixation (ORIF) being the predominant surgical method and the prognosis for this condition is generally favorable. By synthesizing existing knowledge and presenting potential areas of uncertainty, this review aims to offer valuable insights to orthopedic practitioners when they are confronted with this infrequent injury.