Bilateral Tibial Tubercle Avulsion Fractures in Children - Clinical Results of a Rare Fracture.

Abstract:

BACKGROUND:Tibial tubercle avulsion fractures are rare, they represent less than 1% of all physeal fractures. Compared to monolateral tibial tubercle avulsion fractures, bilateral occurrence is even rarer. The purpose of this study is to report about the so far largest group of bilateral avulsion fractures and to compare them to unilateral fractures as well as to current literature. METHOD:All patients who suffered from bilateral tibial tubercle fractures between January 2009 and March 2019 were included. All medical records and radiographs were reviewed and a clinical follow-up was performed. The examined criteria were age, gender, mechanism of injury, classification, risk factors, complications, management and outcomes. Clinical outcome was measured using the well established Tegner activity scale and Lysholm-Gillquist score. The same criteria were analyzed in a literature review of bilateral tibial tubercle fractures to compare our results to available literature. RESULTS:We found four children with bilateral tibial tubercle avulsion fractures. All patients were male with a mean age of 14.5 ± 0.7 years (13 - 15). Mean follow-up examination was 13.6 ± 6.5 months (8 - 29) after surgery. The avulsions occurred during jumping activities in all cases. All children could no longer stand or move because of sudden pain in the knee. We found type IV fractures in three cases, type III fractures in four cases and one type V fracture according to the Ogden classification. All children were treated by open or closed reduction and stabilization with screws or K-wires. Follow-up showed complete fracture healing without complications in all patients. There were no changes in Tegner activity scale and Lysholm-Gillquist Score and knee function comparable to prior to the accident was achieved in all cases. CONCLUSION:Good clinical results without restrictions regarding function of the knee joint can be achieved by direct operative treatment of bilateral tibial avulsion fractures. A reduction in sporting activity has not to be expected. There were no differences between bilateral or unilateral tibial tubercle avulsion fractures. HINTERGRUND:Bei der Avulsionsfraktur der Tuberositas tibiae handelt es sich um eine seltene Verletzung im Wachstumsalter. Das simultane Auftreten der beidseitigen Verletzung ist eine Rarität. Langzeitkomplikationen im Sinne von Achsdeformitäten und Beinlängendifferenzen sind zu vermeiden. Im Rahmen der vorliegenden Arbeit sollen klinische Ergebnisse der beidseitigen Verletzung anhand der bislang größten publizierten Fallserie dargestellt und mit klinischen Ergebnissen der einseitigen Verletzung verglichen werden. MATERIAL UND METHODEN:Alle Jugendlichen, die zwischen Januar 2009 und März 2019 monozentrisch an einer kindertraumatologischen Schwerpunktklinik aufgrund einer beidseitigen Avulsionsverletzung der Tuberositas tibiae behandelt wurden, konnten bis zum Schluss der Wachstumsfugen klinisch sowie radiologisch nachuntersucht werden. Das klinische Ergebnis wurde mittels Tegner-Aktivitätsscore sowie Lysholm-Gillquist-Score retrospektiv zum Zeitpunkt vor dem Unfall sowie zum Zeitpunkt der letzten Follow-up-Untersuchung bestimmt. Alle Frakturen wurden anhand der modifizierten Ogden-Klassifikation eingeteilt. Patientenspezifische Parameter wurden aus dem Krankenhausinformationssystem entnommen. Anhand einer Literaturrecherche wurden die Ergebnisse mit den bislang publizierten Fällen zur beidseitigen/einseitigen Verletzung verglichen. ERGEBNISSE:Vier Patienten (8 Fälle) konnten zur weiteren deskriptiven statistischen Auswertung eingeschlossen werden. Das Alter zum Unfallzeitpunkt betrug 14,5 ± 0,7 Jahre (13 – 15). Das letzte Follow-up erfolgte 13,6 ± 6,5 Monate (8 – 29) nach dem Unfallereignis bei Verschluss der Wachstumsfugen. Nach modifizierter Ogden-Klassifikation zeigte sich in 3 Fällen eine Typ-IV-Verletzung, in 4 Fällen eine Typ-III-Verletzung und in 1 Fall eine Typ-V-Verletzung. In allen Fällen erfolgte die unmittelbare operative Versorgung mittels Schrauben bzw. K-Draht-Osteosynthese. Es konnte in allen Fällen das Aktivitätslevel vor dem Unfallereignis wieder erreicht werden. Tegner-Aktivitätsscore sowie Lysholm-Gillquist-Score zeigten keine Veränderungen zum Ergebnis vor dem Unfallereignis. SCHLUSSFOLGERUNG:Mittels direkter operativer Versorgung im Sinne einer offenen oder geschlossenen Reposition und Stabilisierung mittels Schrauben- und/oder K-Draht-Osteosynthese können sehr gute klinische Ergebnisse mit voller Kniegelenkfunktion und geringen Komplikationsraten nach Schluss der Wachstumsfugen erzielt werden. Eine Rückkehr in die vorherige sportliche sowie Alltagaktivität ist zu erwarten. Im Hinblick auf Alter, Geschlecht, Unfallursache sowie das klinische Ergebnis ergibt sich kein Unterschied zum in der Literatur beschriebenen unilateralen Verletzungsmuster.

journal_name

Z Orthop Unfall

authors

Fernandez Fernandez F,Eberhardt O,Schröter S,Wirth T,Ihle C

doi

10.1055/a-0979-2384

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

466-474

issue

5

eissn

1864-6697

issn

1864-6743

journal_volume

158

pub_type

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