Avulsion Fracture Of The Tibial Tubercle In An Adult Treated With Tension-Band Wiring: A Case Report

摘要

Avulsion fractures of the tibial tubercle are very uncommon injuries, with only 170 cases reported since 1853 ,[ii],[iii]. They account for less than 3% of all physeal injuries in children [iv]. These injuries are extremely rare in adults, with only case reports in the literature. The mechanism of injury in adults is likely to be related to direct injury to the tubercle, rather than by indirect contraction of the quadriceps muscle as seen in children [v]. We described a case report of an 88-year-old female who suffered an avulsion fracture of the tibial tubercle after a simple fall. We performed an open reduction and internal fixation of the tibial tubercle using a cannulated screw and tension-band wire. She had a good functional recovery after 3 months of follow up. Bolesta MJ, Fitch RD. Tibial tubercle avulsions. J Pediatr Orthop 1986; 6: 186-192[ii] Ergun M, Taskiran E, Ozgurbuz C. Simultaneous bilateral tibial tubercle avulsion fracture in a basketball player. Knee Surg Sports Traumatol Arthrosc 2003; 11:163-166[iii] Watson-Jones R. Fractures and joint injuries Vol. 2. 5th ed. Baltimore: Williams & Wilkins; 1976. pp. 1048-1050.[iv] Hamilton SW, Gibson PH. Simultaneous bilateral avulsion fractures of the tibial tuberosity in adolescence: a case report and review of over 50 years of literature. Knee 2006; 13:404-407[v] Vella D, Peretti G, Fra F. One case of fracture of the tibial tuberosity in the adult. Divisione di Ortopedia, Ospedale San Lazzaro, Alba (Cuneo) Case Report An 88-year-old female presented with right knee pain after tripping in the bathroom. She was unable to weight-bear. On examination she had swelling and deformity anteriorly along the proximal tibial shaft, as well as a moderate effusion. She was unable to actively extend her knee and could not straight leg raise. She had a medical history of ischaemic heart disease, hypertension, hypercholesterolaemia and mild dementia. She previously mobilised independently and lived by herself.Plain radiographic examination of the knee revealed an avulsion fracture of the tibial tubercle with extension of the fracture proximally into the joint space [figure 1]. A concomitant fracture of the inferior pole of the patella was also noted. A CT scan was performed to obtain a better understanding of the fracture fragments, however the quality of the images was degraded by movement artefact [figure 2].