Tag Archive for: Fracture

Tibial Tuberosity Fractures in Adolescents: Anatomo – Clinical Assessment and Treatment Results

Volume 10 | Issue 3 | September-December 2024 | Page: 12-18 | Ake YL, Ouattara SJJ, Bonny R, Kouassi-Dria AKS

DOI- https://doi.org/10.13107/ijpo.2024.v10.i03.202

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

 Submitted: 28/10/2024; Reviewed: 10/11/2024; Accepted: 03/12/2024; Published: 10/12/2024

Authors: Ake YL [1], Ouattara SJJ [1], Bonny R [1], Kouassi-Dria AKS [1]

[1] Department of Paediatric Surgery, Cocody Teaching Hospital, Abidjan, Ivory Coast

Address of Correspondence

Dr. Ake Yapi Landry
Associate Lecturer, Department of Paediatric Surgery, Cocody Teaching Hospital, Abidjan, Ivory Coast
Email: akeyapilandry@yahoo.fr

Abstract

Background: The objective of this study was to describe the anatomo-clinical, therapeutic aspect of TT fractures and the results.
Methods: This retrospective study was conducted over a period of 5 years (01 January 2018 to 01 January 2023) in the Paediatric Surgery Department of the Teaching Hospital and at theInternational clinic. The epidemiological- clinical, anatomopathological, therapeutic, and the results variables of TT fractures were studied.
Results: Data from 10 cases were included in this study. All patients were male, and their mean age was 14.3 years [range: 11-15 years]. All fractures occurred during sports activities through indirect mechanisms. Fractures occurred on both the left and right sides of the knee. We have compiled fractures of type IB (2 cases), type IIB (03 cases), IIIA (01 case), type IIIB (03 cases), and type IV (01 case). All patients underwent open reduction and osteosynthesis. No complications occurred in any of the patients, and their long-term results were satisfactory.
Conclusion: TT fractures are uncommon in adolescents; however, they are common in sports that involve jumping. The indications for treatment are based on the modified Ogden classification. These fractures have a good prognosis, with full recovery of function and activity after consolidation.
Keywords: Fracture, Tibial tuberosity, Adolescence

References

1. Casas L, Romero I, Orivio G. Traitement de la fracture avulsion de la tubérosité tibiale antérieure chez les adolescents. Acta Ortop Mex2013;27: 160–69.
2. Behery OA, Feder OI, Beutel BG, et al. Combined Tibial Tubercle Fracture and Patellar Tendon Avulsion: Surgical Technique and Case Report. J Orthop Case Rep 2018; 8:18–22. doi: 10.13107/jocr.2250-0685.1090.
3. Wendell W, Symone M, Bryan V. Epidemiology, diagnosis, and management of Tibial Tubercle Avulsion Fractures in Adolescents. JBJS Rev 2020; 8: e0186. doi: 10.2106/JBJS.RVW.19.00186.
4. Aleilimar T, Leonardo J, Ulbiramar C. Anterior avulsion fracture of the tibial tuberosity in adolescents – Two case reports. Rev Bras Ortop 2016; 51:610–3. doi: 10.1016/j.rboe.2016.08.001.
5. Pranav C, Raja A, Sherlin L, et al. Imaging Review of Adolescent Tibial Tuberosity Fractures. Open J Med Imaging 2013; 3:90–6. doi:10.4236/ojmi.2013.33014.
6. Pretell-Mazzini J, Derek M, Jeffrey R. Outcomes and Complications of Tibial Tubercle Fractures in Pediatric Patients: A Systematic Review of the Literature. J Pediatr Orthop 2016; 36:440–6. doi:
10.1097/BPO.0000000000000488.
7. Watson-Jones R. Fractures and joint injuries. 5th ed. Baltimore, USA, Williams & Wilkins Company, 1979:1048–50.
8. Ogden JA, Tross RB, Murphy MJ. Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am 1980; 62:205–15.
9. Checa Betego N, Arvinius C, Cabadas G. Management of pediatric tibial tubercle fractures: is surgical treatment really necessary? J Orthop Surg Trauma 2019; 29:1073 9. doi: 10.1007/s00590-019-02390-x.
10. Reuter S, Mellerowicz H. Avulsionsverletzungen der proximalen Tibia. Der Orthopäde 2016; 45:226–32. doi:10.1007/s00132-016-3228-y.
11. Fnini S, Sirajhak M, Messoudi A. Fracture-avulsion négligée de la tubérosité tibiale antérieure. J Traumatol du Sport 2011; 28:257–60. doi: 10.1016/j.jts.2011.10.001.
12. Bombah FM, Nana T, Ekani BY, et al. Fracture-avulsion of tibial tubercle apophyseal in two Cameroonian adolescents. Trauma Case Rep 2021;35: 100525. doi: 10.1016/j.tcr.2021.100525.
13. Pace JL, McCulloch PC, Momoh EO, et al. Operatively TreatedType IV Tibial Tubercle Apophyseal Fractures. J Pediatr Orthop2013; 33:8–9. doi: 10.1097/BPO.0b013e3182968984.
14. Khoriati AA, Guo S, Thakrar R, et al. Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature. Injury 2015;46: 767–9. doi: 10.1016/j.injury.2015.01.012.
15. Kunis GW, Berko JA, Shogan JC, et al. Tibial Tubercle Avulsion Fractures in Adolescents: A Narrative Review and Case Report. J Orthop & Orthopedic Surg. 2021; 2:12–8. doi: 10.29245/2767-5130/2021/3.1149.
16. Frey S, Hosalkar H, Cameron DB. Tibial tuberosity fractures in adolescents. J Child Orthop 2008; 2:469–74. doi: 10.1007/s11832-008-0131-z.
17. Brey JM, Conoley J, Canale ST, et al. Tibial Tuberosity Fractures in Adolescents: Is aPosterior Metaphyseal Fracture Component a Predictor of Complications? J Pediatr Orthop 2; 32:561–6. doi: 10.1097/BPO.0b013e318263a370.
18. Franz P, Luderowski E, Tuca M. Tibial tubercle avulsion fractures in children. Curr Opin Pediatr 2020; 32:86–92. doi:10.1097/MOP.0000000000000870.
19. Bauer T, Milet A, Odent T. Fracture-avulsion de la tubérosité tibiale antérieure chez l’adolescent À propos de 22 cas et revue de la littérature. Rev Chir Orthop Reparatrice Appar Mot 2005; 91:758–67
20. Hannouche D, Duparc F, Beaufils P. The arterial vascularization of the lateral tibial condyle: anatomy and surgical applications. Surg Radiol Anat 2006; 28:38–45. doi: 10.1007/s00276-005-0044-1.
21. Driss Jeddi, El Maqrout A, Kharmaz M. Avulsion fracture of anterior tibial tuberosity in a sporty adolescent. Sch J App Med Sci2019; 7(2):728–9. doi: 10.21276/sjams.2019.7.2.61.
22. Checa Betegón P, Arvinius C, Cabadas González M, et al.Management of pediatric tibial tubercle fractures: Is surgicaltreatment really necessary? Eur J Orthop Surg Traumatol2019; 29:1073–9. doi: 10.1007/s00590-019-02390-x.
23. Jakoi A, Freidl M, Old A, et al. Tibial Tubercle AvulsionFractures in Adolescent Basketball Players. Orthopedics2012; 35:692–6. doi: 10.3928/01477447-20120725-07.
24. Rodriguez I, Sepúlveda M, Birrer E, et al. Fracture of the anterior tibial tuberosity in children. EFORT Open Rev 2020; 5:260–7. doi: 10.1302/2058-5241.5.190026.
25. Mubarak SJ, Kim JR, Edmonds EW, et al. Classification of proximal tibial fractures in children. J Child Orthop 2009; 3:191–7. doi: 10.1007/s11832-009-0167-8.
26. Pandya NK, Edmonds EW, Roocroft JH, et al. Tibial tubercle fractures: complications, classification, and the need for intra- articular assessment. J Pediatr Orthop 2012; 32:749–59. doi:10.1097/BPO.0b013e318271bb05.
27. Clarke DO, Franklin SA, Wright DE. Avulsion fracture of the tibial tubercle associated with patellar tendon avulsion. Orthopedics2016;39: e561–4. doi: 10.3928/01477447-20160414-02.
28. Goh TC, Abdul Halim AR. Avulsion Fractures of the Bilateral Tibial Tuberosity in an Adolescent: A Case Report and Literatures Review. European Journal of Clinical and Biomedical Sciences2018; 4:73–5. doi: 10.11648/j.ejcbs.20180406.12.
29. Pesl T, Havranek P. Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method. J Child Orthop. 2008; 2:353–6. doi: 10.1007/s11832-008-0126-9.
30. Nicolini AP, Carvalho RT, Ferretti M, et al. Simultaneous bilateral tibial tubercle avulsion fracture in a male teenager: case report and literature review. J Pediatr Orthop B. 2018; 27:40–6. doi:10.1097/BPB.0000000000000313.
31. Zaizi A, El Yaacoubi T, Chafry B, et al. Tibial tubercle avulsion fractures in school sports injury: A case report. Int J Surg Case Rep2019; 58:30–2. doi: 10.1016/j.ijscr.2019.03.017.
32. Ares O, Seijas R, Cugat R. Treatment of fractures of the tibial tuberosity in adolescent soccer players. Acta Orthop Belg 2011; 77:78–82.
33. Arkader A, Schur M, Refakis C, et al. Unicortical Fixation is Sufficient for Surgical Treatment of Tibial Tubercle Avulsion Fractures in Children. J Pediatr Orthop 2019;39: e18–e22. doi:10.1097/BPO.0000000000001269.
34. Behery OA, Feder OI, Beutel BG, et al. Combined tibial tubercle fracture and patellar tendon avulsion: Surgical technique and case report. J Orthop Case Rep. 2018; 8:18–22. doi: 10.13107/jocr.2250- 0685.1090.
35. Fernández EV, de la Mora García AS. Avulsion fracture of the anterior tuberosity of the tibia in adolescents. Cuban Journal of Orthopedics and Traumatology 2017; 30:1–2.
36. Buckinx F, Bornheim S, Remy G, et al. French translation and validation of the “Anterior Knee Pain Scale” (AKPS) Disabil Rehabi2019;41:1089–94. doi: 10.1080/09638288.2017.1419288.

How to Cite this Article:  Ake YL, Ouattara SJJ, Bonny R, Kouassi-Dria AKS | Tibial Tuberosity Fractures in Adolescents: Anatomo – Clinical Assessment and Treatment Results | International Journal of Paediatric Orthopaedics | September-December 2024; 10(3): 12-18.

(Article Text HTML)      (Full Text PDF)

Apophyseal Metaphyseal combination injury to Olecranon in a healthy Adolescent – A rare injury and review of literature

Vol 1 | Issue 1 | July-Sep 2015 | page:51-53 | Ganesh Singh Dharmshaktu, Anshuman Vijay Roy.

Authors : Ganesh Singh Dharmshaktu[1], Anshuman Vijay Roy[2].

[1] Department of Orthopaedics, Government Medical College, Haldwani , Uttarakhand.

[2] Department of Orthopaedics, Krishna Hospital and Research Centre, Haldwani , Uttarakhand.

Address of Correspondence
Dr. Ganesh Singh Dharmshaktu , Department of orthopaedics , Government Medical College , Haldwani ( Uttarakhand ) . PIN -263139. Email: drganeshortho@gmail.com

Abstract

Background: Apophyseal injuries of olecranon have limited number of case reports and series owing to its rarity. Pure apophyseal avulsions are very rare and so are apophyseal metaphyseal combination injuries. No guidelines exist for the uniformity of the treatment and various modalities have been tried in sporadic reports. A keen clinical observation is required to suspect the possibility of these injuries followed by good imaging confirmation. Concordance of associated disorders like osteogenesis imperfecta with such injuries underlines the importance of ruling out this clinical entity in such cases.
Keywords: Fracture, Apophysis, Olecranon, Injury. Tension band wiring.

Introduction
Upper extremity is common site of bony injuries in children with reported incidence of 65% to 75% in the literature. 7% to 9% of these injuries are elbow injuries.[1] Apophysis is a term usually applied to an epiphysis that is subjected to traction by muscle insertion and its physiological pull.[2] The injury to the region if displaced can cause serious morbidity and functional limitation and thus warrants appropriate treatment. Non operative management is limited to only undisplaced injuries while injuries with more than 3-5 mm. of displacement warrants open reduction followed by fixation with varying methods. Open reduction and compressive fixation has widely been tried successfully with various implants like screws, tension band wiring or resorbable sutures. There has not been significant growth related problem with compression forces as a result of internal fixation.[2]

Case Report
A 12 year old boy was presented to us with history of injury to his right elbow following fall from height two days back. He was taken to a local practitioner before coming to us with a make do splint of wooden sticks. There was swelling, pain and difficulty in using the affected limb. There was tenderness present and swelling more over the posterior aspect but no raised temperature and intact distal neurovascular status. There was no appreciable crepitus or frank abnormal mobility present and a proper elbow examination including range of motion status was limited by swelling and pain. The radiograph of the affected elbow showed an apophyseal-metaphyseal combination injury with displacement. The olecranon apophysis with a rim of metaphysis was avulsed. There was no associated injury present. There was neither any history of frequent or multiple bony injuries in the past related or remote to present condition nor presence of blue sclera or abnormal dentition. The parents of the boy were explained and advised operative intervention of the injury. Following an informed consent of parents in view of patient being minor and under aseptic precautions open reduction and internal fixation was planned and carried out.

Figure 1, 2, 3 final

Result
The open reduction and internal fixation was performed and secured with tension band wiring (TBW). The posterior approach was used to access the injury site, The avulsed part was provisionally reduced and held together with pointed clamps while TBW was carried out in standard manner using two parallel Kirschner’s wires and a wire loop in figure of eight fashion. The operation went uneventful and so was peri-operative period. The stitches were removed on tenth day and patient was advised supervised physiotherapy after two weeks. The follow up initially at three, six twelve weeks and then after three and six months were uncomplicated and the range of motion improved all this while. The final follow up at six months showed normal range of motion as compared to contra-lateral side. There was no problem with hardware in the follow up and those were removed subsequently after months.

Discussion
The type 3 injuries related to olecranon apophyses are complete fractures with type 3 (a) as pure avulsions and type 3(b) as apophyseal-metaphyseal combination injuries.[2] Type 3(b) injuries are commoner in older children while type 3(a) usually involves younger children. This pattern of injury has been likened to Salter-Harris type 2 injury.[3] Apophyseal injuries of olecranon are uncommon with limited reported incidents.[4] Most of these injuries have been associated with patients of osteogenesis imperfecta.[5] Osteognesis imperfecta cases ( like tarda form) show higher incidences for this injury.[6] Apart from the fact that olecranon apophyses fractures are reported in relation with 50% cases of osteogenesis imperfecta, there have been reportedly higher rates of complication such as refracture in them.[7] It has been advised that hardwares should be maintained even after union in cases of osteogenesis imperfect due to this risk.[5,7] The elbow has rich vascularity with extraosseus network as well as intraosseus one.[8,9] The undisplaced fractures are amenable to conservative treatment with plaster of paris slab or cast and fracture unite well if length, angulation and rotation is properly taken care of. The displaced fractures has been managed with tension band wiring in most instances with fair to excellent results.[3,7,10] Some authors have used trans- osseous suture fixation for the fractures with good results.[11] Use of absorbable wires as supplemental fixation have also been reported.[12] As most of these injuries occur in children near skeletal maturity, no significant growth related problem is seen as compressive fixation across physes. The presented case is an uncommon variant of apophyseal olecranon injury in a normal child managed satisfactorily with appropriate techniques.

References

1. Landin LA, Danielsson LG. Elbow fractures in children: an epidemiological analysis of 589 cases. Acta Orthop Scand 1986; 57:309.
2. Erickson M, Frick S. Fractures of the proximal radius and ulna.In Beaty JH, Kasser JR. editors. Rockwood and Wilkins Fractures in children 7th ed. Philadelphia: Lippincott Williams and Wilkins;2010: 427-431.
3. Granthan SA, Kiernan HA. Displaced olecranon fractures in children. J Trauma 1975;15197-204.
4. Carney JR, Fox D, Mazurek MT. Displaced apophyseal olecranon fracture in a healthy child. Mil Med. 2007;172(12):1225-7.
5. Zionts LE, Moon CN. Olecranon apophysis fractures in children with osteogenesis imperfecta revisited. J Pediatr Orthop.2002; 22(6):745-50.
6. Di Cesare PE, Sew-Hoy A, Krom W. Bilateral isolated olecranon fractures in an infant as presentation of osteogenesis imperfect. Orthopedics 1992; 15:741-743.
7. Gwynne-Jones DP. Displaced olecranon apophyseal fractures in children with osteogenesis imperfecta. J Pediatr Orthop. 2005; 25(2):154-7.
8. Wilson PD. Fractures and dislocations in the region of elbow. Surg Gynecol Obstet 1933;56:335-359.
9. Haraldsson S. The intraosseous vasculature of the distal end of humerus with special reference to capitellum. Acta Orthop Scand 1957;27:81-93.
10. Poland J. A Practical Treatise on Traumatic Separation of the Epiphyses. London; Smith, Elder & Co, 1898.
11. Rath NK, Carpenter EC, Thomas DP. Traumatic pediatric olecranon injury: a report of suture fixation and review of the literature. Pediatric emergency care 2011; 27(12):1167-9.
12. Gortzak Y,Mercado E, Atar D, et al. Pediatric olecranon fractures: open reduction and internal fixation with removable Kirschner wires and absorbable sutures. J Pediatr Orthop 2006;26:39-42
.

How to Cite this Article: Dharmshaktu GS, Roy AV. Apophyseal- metaphyseal combination  injury to olecranon in a healthy adolescent – A rare injury and review of literature. International Journal of Paediatric Orthopaedics July-Sep 2015;1(1):51-53.     

 (Abstract)      (Full Text HTML)      (Download PDF)