Tibial Tuberosity Avulsion Fracture

Aka: Tibial Tuberosity Avulsion Fracture, Tibial Tubercle Avulsion Fracture, Tibial Tuberosity Closed Fracture

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II. Epidemiology

  1. Most common in boys ages 12 to 15 years old

III. Physiology

  1. Tibial tuberosity or tubercle is a proximal tibia Ossification Center
  2. Tibial tuberosity forms the distal insertion or anchor point of the Patellar tendon

IV. Pathophysiology

  1. Tibial Tuberosity Fracture occurs in skeletally immature patients (Muscles/tendons stronger than bone)
  2. Injury mechanism
    1. Forceful quadriceps contraction during Exercise (e.g. jumping)
    2. May occur with forced knee flexion while quadriceps is contracted
    3. May occur simply with Running in those at risk

V. Risk Factors

  1. Obesity (Body Mass Index >97th percentile for age)
  2. Low weight (Body Mass Index <5th percentile for age)

VI. Management

  1. Initial Management
    1. Knee Immobilizer or long leg splint
    2. Precautions regarding Compartment Syndrome (see below)
  2. Definitive Management
    1. Long leg cast in extension
    2. Open reduction and internal fixation indications
      1. Complex Fractures involving the proximal tibia
      2. Displaced Tibial Tuberosity Fractures

VII. Complications

  1. Compartment Syndrome (2 to 20% of Tibial Tuberosity Fractures)
    1. Associated with injury to the anterior recurrent tibial artery (lies lateral to the tibial tuberosity)
    2. Higher risk with more complex Fractures extending into proximal tibia

VIII. References

  1. Broder (2024) Crit Dec Emerg Med 38(2): 20-1
  2. Reyes (2023) Curr Rev Musculoskelet Med 16(9): 392-7 +PMID: 37436650 [PubMed]

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