Spiked Washer-Augmented Screw Fixation for Bilateral Tibial Tuberosity Avulsion Fractures in an Adolescent: A Case...

Bilateral tibial tuberosity avulsion fractures (TTAF) are among the rarest and most significant injuries affecting the extensor mechanism in skeletally immature patients. Successful treatment mandates acute anatomical reduction and stable internal fixation that accounts for high quadriceps tensile forces and the risk of physeal growth arrest.

A 14-year-old male sustained an acute, displaced bilateral TTAF (Modified Watson-Jones/Ogden Type II) after a vigorous, simultaneous jump and landing. The patient presented with partial bilateral loss of active knee extension. Acute open reduction and internal fixation (ORIF) was performed. The fixation involved one 4.0 mm cannulated cancellous (CC) screw per knee. The critical technical detail was the use of a spiked washer under the head of the CC screw on both sides, ensuring enhanced fragment compression, stability, and anti-rotation against the deforming forces of the quadriceps.

The patient was followed up for one year. Radiographs confirmed complete, solid bony union of both tibial tuberosities with no secondary displacement, hardware complication, or evidence of proximal tibial physeal arrest (e.g., tibia recurvatum). Clinically, the outcome was excellent, with a full, pain-free range of motion, measuring 0° extension to 135° flexion bilaterally. The patient achieved a full, unrestricted return to competitive sports activities.

ORIF using CC screws strategically augmented by spiked washers offers a biomechanically superior and reliable fixation strategy for displaced bilateral TTAF in young children. This approach promotes rapid and stable bony fusion, preserves proximal tibial growth, and consistently achieves excellent functional outcomes.