From the Guidelines
A 20-year-old male with a tibial tuberosity avulsion fracture requires prompt orthopedic consultation for surgical fixation to restore the attachment of the patellar tendon and preserve knee function. The diagnosis of this condition is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1. Initial treatment includes non-weight bearing on the affected leg, knee immobilization in extension with a knee brace or splint, ice application for 20 minutes every 2-3 hours, elevation of the limb above heart level when resting, and pain control with NSAIDs such as ibuprofen 600mg every 6 hours or naproxen 500mg twice daily.
- Key considerations in management include:
- Prompt surgical intervention, ideally within 7-10 days of injury, to minimize the risk of long-term complications
- Post-operative rehabilitation with 4-6 weeks of protected weight bearing followed by progressive strengthening exercises
- Pain management with acetaminophen 1000mg every 6 hours, which can be added to NSAIDs for additional relief
- The importance of restoring the attachment of the patellar tendon to prevent complications such as patella alta, quadriceps weakness, and knee extensor dysfunction. According to the american college of foot and ankle surgeons, surgery is the usual treatment for tibial tuberosity avulsion fractures, except in cases where fracture fragments are small, nonarticular, or minimally displaced, where simple immobilization may be appropriate 1.
From the Research
Treatment Options for Tibial Tuberosity Avulsion Fracture
- Surgical treatment is often necessary for tibial tuberosity avulsion fractures, especially in cases with significant displacement 2, 3, 4, 5.
- Open reduction and internal fixation (ORIF) is a common method used to treat these fractures, with the goal of restoring the joint surface and the extensor mechanism 2, 4, 5.
- Tension band wiring can be used as a supplement to internal fixation to provide stable reduction and promote healing 2, 4.
- Closed reduction and internal fixation (CRIF) may be considered as a first-line treatment for displaced intraarticular fractures, such as Ogden's type 3A or 3B fractures 5.
Rehabilitation and Outcomes
- Early mobilization and rehabilitation are crucial for optimal outcomes in patients with tibial tuberosity avulsion fractures 2, 3, 6, 4.
- Patients can expect excellent functional results and return to their previous athletic activities with proper treatment and rehabilitation 2, 3, 6, 4.
- The use of platelet-rich plasma (PRP) as an adjunct to enhance soft tissue healing may also be beneficial in some cases 6.
Classification and Diagnosis
- The Ogden classification system is commonly used to describe the type of tibial tuberosity avulsion fracture 3, 4, 5.
- Computed tomography (CT) scans may be necessary to establish the precise configuration of the fracture and exclude concomitant injuries 3.
- A high index of suspicion for coexisting fractures or soft tissue injuries is essential when treating avulsion fractures of the tibial tuberosity 3.