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Orthop J Sports MedOrthop J Sports MedOJSspojsOrthopaedic Journal of Sports Medicine2325-9671SAGE Publications Sage CA: Los Angeles, CA 10.1177/2325967118S0013410.1177_2325967118S00134ArticleTibial Tubercle Fractures in Children and Adolescents Haber Daniel B. MD1Tepolt Frances MD2McClincy Michael P. MD3Kalish Leslie ScD4Kocher Mininder S. MD, MPH41 Massachusetts General Hospital, Boston,
MA, USA2 Boston Children’s Hospital, Boston, MA,
USA3 Children’s Hospital (Boston) Program,
Boston, MA, USA4 Boston Children’s Hospital, Boston, MA,
USA27 7 2018 7 2018 6 7 suppl4 2018 AOSSM Annual Meeting Abstracts2325967118S00134© The Author(s) 20182018SAGE PublicationsThis open-access article is published and distributed under the
Creative Commons Attribution - NonCommercial - No Derivatives License
(http://creativecommons.org/licenses/by-nc-nd/4.0/), which
permits the noncommercial use, distribution, and reproduction of the article
in any medium, provided the original author and source are credited. You may
not alter, transform, or build upon this article without the permission of
the Author(s). For article reuse guidelines, please visit SAGE’s website at
http://www.sagepub.com/journals-permissions.Objectives:
To report patient characteristics, fracture types, treatment methods, and
clinical outcomes of children and adolescents treated for tibial tubercle
fractures.

Methods:
Patients age 19 and under treated for tibial tubercle fractures at a single
institution from 1995 to 2015 were identified and their medical records were
retrospectively reviewed. Clinical and radiographic outcomes were reported
for patients with a minimum follow up of 6 months. Associations were tested
using Fisher’s exact test.

Results:
Two-hundred thirty seven tibial tubercle fractures were identified in 229
patients; 198 (86%) male. There were 139 (59%) left sided injuries. Mean age
was 14.3 years (range 4.9 - 19.8). Mean body mass index (BMI) was 25.
Osgood-Schlatters was identified in 72 (30%) cases and was most commonly
associated with Ogden type I fractures (p<0.001). Two-hundred and four
(86%) fractures occurred while participating in athletics, most commonly
basketball (87, 43%). Of the 228 cases for which mechanism of injury was
identified, 69 (30%) occurred while landing, 60 (26%) resulted from a direct
blow to the knee, and 51 (22%) occurred while jumping. Ogden III fractures
were most common (96, 41%) followed by Ogden I fractures (67, 28%). Initial
treatment was surgical for 158 (67%) fractures, of which 58 (37%) underwent
reoperation, 53 (34%) for hardware removal. Ogden I fractures were most
commonly treated non-operatively (91%) and Ogden II-V fractures were most
commonly treated operatively (89%, p<0.001). Elevated BMI was associated
with Ogden II-V fractures (p=0.003) and injuries requiring operative
treatment (p<0.001). Compartment syndrome was identified in 4 (2%)
injuries and required emergent fasciotomy. Prophylactic anterior and/or
lateral fasciotomy was performed in 35 (15%) operatively treated injuries.
Of the 117 (49%) patients for whom minimum 6-month follow up was documented,
103 (88%) returned to sports; among those treated operatively (87), 2 (2%)
developed symptomatic limb length discrepancy, 1 (1%) developed tibial
recurvatum, and 6 (7%) developed post-operative infection. At last follow
up, 39 (45%) of surgical patients reported pain at the tibial tubercle, 23
(26%) reported pain with squatting, and 13 (15%) had patellar tendonitis.
Thirty-seven (43%) complained of hardware prominence.

Conclusion:
Tibial tubercle fractures occur most commonly in adolescent male athletes and
are associated with basketball, elevated BMI, Osgood-Schlatters, and a risk
of compartment syndrome. Following treatment, most patients return to sport.
As the largest single series of tibial tubercle fractures reported, this
study provides valuable insight into injury epidemiology, relationship with
Osgood Schlatters, and clinical outcomes.

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