MRI may add in correct staging of the lesion. In our case the maximum gap of the growth plate measured seven millimetres, therefore surgical repair, consisting of open reduction and internal fixation with cortical screws, was performed, followed by six weeks of immobilization in a plaster cast.įurther follow-up was uneventful five months after trauma.Īlthough rare, avulsion fracture of the TT should be considered in sportive adolescents particularly in jumping. If displacement is marked or if the physis is comminuted, surgical approach is recommended. The treatment, either conservative versus surgical, depends on correct staging of the lesion. After MRI the lesion was classified as a type II fracture. In addition, MRI revealed bone marrow oedema in the ventral part of the proximal tibial epiphysis indicating lesion extension in the articular surface of the tibia. In our case, the plain radiograph showed an enlargement of the growth plate of the TT. Īlthough MRI is not always mandatory, it may be of additional value to define the precise extent of the bone and soft tissue abnormalities, and allows a more accurate classification of the lesion. Plain radiographs are the first step to define the displacement of the fracture, the degree of comminution and the extent of the injury. The extent of the injury is related to the stage of fusion of the epiphysis. Ryu and Debenham introduced an additional fourth category in which the fracture extends into the proximal tibial epiphysis. The original classification of Watson and Jones described three categories of avulsion fractures of the tibial tubercle. Īvulsion fractures of the tibial tubercle (TT) are classified according to the modified Watson-Jones classification (Fig. The mechanism of injury is thought to be a high energy extension of the knee against a fixed leg, such as in jumping sports. Fractures of the apophysis of the proximal tibia comprise 0.5% - 3% of all fractures. Avulsion fractures of the knee are uncommon compared to avulsion fractures of the hip or the pelvis. Typically avulsion fractures occur in boys between the age of 13-17 years because of the cartilage features of the growth plate. In adolescents the growth plate is the weakest link, in comparison to adults where a tensile force will cause injuries of the musculotendinous junctions. An avulsion fracture is caused by a high energy tensile force on a ligament or tendon which exceeds the strength of the bony tissue.
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