Slobogean G P, Mulpuri K, Alvarez C M, Reilly C W
Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
J Orthop Surg (Hong Kong). 2006 Dec;14(3):319-21. doi: 10.1177/230949900601400316.
A 16-year-old male had simultaneous bilateral tibial tubercle avulsion fractures after making a sudden stop while running at full speed. The left knee injury (type V) was minimally displaced, was treated conservatively with closed reduction, and the patient recovered uneventfully. The right tibial tubercle injury was unusual. The tuberosity and anterior aspect of the proximal epiphysis remained as one, but there was severe intra-articular comminution posterior to the displaced tubercle fragment. The right knee injury (type III) required open reduction and internal fixation to reduce the apophyseal fragment and 2 intra-articular displaced fragments. The patient's recovery was complicated by a severe, persistent flexion deformity on the right side. Eventually, the patient required manipulation under anaesthesia, extensive continuous passive mobilisation and a turnbuckle extension splint. A residual 5-degree flexion deformity remained at 16 months post-injury. This case highlights the importance of identifying any intra-articular fragments, their careful anatomical reduction, and aggressive mobilisation when treating tibial tubercle avulsion fractures.
一名16岁男性在全速奔跑时突然停下后，双侧胫骨结节同时发生撕脱骨折。左膝损伤（V型）移位极小，采用闭合复位保守治疗，患者顺利康复。右胫骨结节损伤较为特殊。结节与近端骨骺的前部仍连为一体，但在移位的结节碎片后方存在严重的关节内粉碎。右膝损伤（III型）需要切开复位内固定，以复位骨骺碎片和2个关节内移位碎片。患者的康复因右侧严重且持续的屈曲畸形而复杂化。最终，患者需要在麻醉下进行手法治疗、广泛持续的被动活动以及使用螺旋扣伸展夹板。伤后16个月仍残留5度的屈曲畸形。该病例强调了在治疗胫骨结节撕脱骨折时识别任何关节内碎片、仔细进行解剖复位以及积极活动的重要性。
