Risk Factors for Stiffness After Fixation of Tibial Tubercle Fractures: A Multicenter Study From the TITUS Group

Area of Science:

• Pediatric Orthopedics
• Traumatology
• Surgical Outcomes Research

Background:

• Persistent stiffness is a significant complication following operative treatment of tibial tubercle fractures (TTFs) in children, impacting functional recovery.
• Limited data exists on risk factors for stiffness after TTF fixation due to the fracture's rarity.

Purpose of the Study:

• To identify risk factors associated with persistent stiffness after surgical fixation of tibial tubercle fractures in pediatric patients.

Main Methods:

• A multicenter retrospective comparative study included operatively managed TTFs in patients under 18 years.
• Persistent stiffness was defined as a loss of ≥20° knee flexion at 3 months post-surgery compared to the contralateral knee.
• Univariable and multivariable regression analyses were performed to identify significant risk factors.

Main Results:

• The incidence of persistent stiffness was 3.0% among 369 included patients.
• Delayed surgical fixation (>24 hours from presentation) and prolonged postoperative immobilization (>4 weeks) were significantly associated with increased odds of stiffness.
• Specifically, fixation >24 hours increased stiffness odds by 9.7 times, and immobilization >4 weeks by 10.3 times.

Conclusions:

• Delayed surgical fixation and extended postoperative immobilization are key risk factors for persistent stiffness after pediatric TTF surgery.
• Surgeons should consider these findings when planning treatment timing and postoperative management protocols to minimize flexion deficits.