Paediatric tibial tubercle fractures - A retrospective case series

Tibial tubercle fractures (TTFs) are rare injuries in adolescents, representing 3% of all proximal tibia fractures and less than 1% of all physeal fractures. Despite their low incidence, they can be associated with significant complications such as periosteal stripping, vascular compromise, compartment syndrome and intra-articular damage. Given the increasing incidence due to youth sports participation and the limited existing literature, this study aimed to describe patient characteristics, treatment methods, outcomes, and complications in children aged 8-16 years with TTFs.

A retrospective cohort study was conducted at a level 2 trauma centre in the Netherlands, including 40 patients (41 fractures) between 2008 and 2023. The mean age at injury was 14.3 years, and 95% (38/40) of cases occurred in males, predominantly during sports activities. Thirty-two fractures (78% (31/41)) required surgical treatment, most commonly with screw fixation, while nine fractures (22% (9/41)) were treated non-operatively. The total complication rate was 9.8% (4/41), including two refractures and one implant loosening, all within the surgically treated group. No compartment syndromes were reported. At the end of follow-up 93.5% (29/31) of surgically treated patients and 77.8% (7/9) of non-surgically treated patients had returned to sport.

Tibial tubercle fractures in adolescents occur mostly in males during sports. The surgical treatment is not standardized and can be custom made per fracture. Patients receiving surgical or non-surgical treatment both have a good chance to return to sport after this specific injury.