Displaced Tibial Tubercle Fractures in Adolescent Athletes

Background: Tibial tubercle fractures are rare proximal tibial physeal injuries that most commonly occur during sports activity in teenagers. The association of compartment syndrome with tibial tubercle fractures, as well as the need for advanced imaging and bi-cortical screw fixation are controversial. The purpose of this study is to report the surgical outcomes of treating displaced tibial tubercle fractures, including the incidence of compartment syndrome, the need for advanced imaging, and utilization of unicortical screws

Methods: The study was approved by the College of Medicine Institutional Review Board. A retrospective review was performed on patients who underwent open reduction and internal fixation of tibial tubercle fractures from 2015-2019. Patient demographics, injury characteristics, imaging used, fixation used, preoperative or postoperative compartment syndrome, other postoperative complications, growth plate arrest, and time to return to pre-injury sports were recorded.

Results: 19 male patients were identified. The average age was 14.6 years, and the average BMI was 25.3. The mechanism of injury was primarily athletic activity including 12 (63%) basketball, 2 (11%) football, 2 (11%) soccer, 1 (5%) skateboarding, 1 (5%) ultimate frisbee, and 1 (5%) gymnastics. All patients received plain radiographs and 2 (10%) patients had an additional Computed Tomography scan. 1 (5%) patient presented with symptoms of compartment syndrome, and fasciotomy was performed. 12 (63%) patients received prophylactic fasciotomy at the time of ORIF that was determined on a case-by-case basis by the treating physician. No bicortical screws were used. Unicortical screws/pins and immobilization were used in all cases with no cases of loss of fixation or popliteal artery injury. No growth issues, such as angular growth or shortening, occurred. The average follow-up time was 14 months. The 19 patients (100%) who played sports were able to return to their pre-injury level of activity.

Conclusion: Displaced tibial tubercle fractures occurred exclusively in male adolescents during sports activity. All patients received unicortical screw fixation. 100% of patients were able to return to pre-injury athletic activities. One incidence of compartment syndrome occurred. CT imaging was not required. Although these fractures occured through the proximal tibial growth plate, growth plate arrest did not occur due to the advanced skeletal age of the patients.