Khoriati Al-Achraf, Guo Shigong, Thakrar Raj, Deol Rupinderbir S, Shah Khalil Y
Department of Trauma & Orthopaedic Surgery, Lister Hospital, Stevenage SG1 4AB, UK.
Department of Trauma & Orthopaedic Surgery, Lister Hospital, Stevenage SG1 4AB, UK.
Injury. 2015 Apr;46(4):767-9. doi: 10.1016/j.injury.2015.01.012. Epub 2015 Jan 16.
An avulsion fracture of the tibial tubercle is an uncommon injury, comprising less than 1% of all physeal injuries. The occurrence of such injuries bilaterally is even rarer. We report a case of bilateral atraumatic tibial tubercle avulsion fractures and its presentation, mechanism of injury, surgical management, post-operative rehabilitation and implications for clinical practice. A 17-year-old healthy male presented to the emergency department with severe pain on the anterior aspect of both knees and was unable to walk, having been brought in by ambulance after hearing a crack whilst jogging. On examination, there was significant swelling of both knees which were held in extension. On both sides there was a prominent deformity on the region of the tibial tubercle with a palpable gap, although no open skin wound. He was unable to actively move either knee joint. No neurovascular deficit was present. Plain radiographs revealed bilateral tibial tubercle avulsion fractures. Gentle manipulation was performed in the emergency department to the fragments in order to remove the tension from the skin. The fragments were reduced and fixed surgically with 4mm cannulated screws in an anterior to posterior direction. Both limbs were placed in temporary casts in 20 degrees of flexion. Postoperatively, the patient was kept non-weight bearing for four weeks then placed into a range of motion brace and movement commenced. Full weight bearing was permitted at the one month stage and he was advised to avoid any sporting activity until the 8 week stage and contact sports until the 10 week stage. Full movement of both joints was regained and the patient returned to full sporting activity in the absence of symptoms. This case emphasises the need for a high degree of vigilance when faced with such a presentation and a low threshold for further investigation and surgical intervention.
胫骨结节撕脱骨折是一种罕见的损伤，占所有骨骺损伤的比例不到1%。双侧发生这种损伤的情况更为罕见。我们报告一例双侧非创伤性胫骨结节撕脱骨折病例，包括其临床表现、损伤机制、手术治疗、术后康复以及对临床实践的启示。一名17岁健康男性因双膝关节前部剧痛被送往急诊科，无法行走，他在慢跑时听到一声脆响后被救护车送来。检查发现双膝关节明显肿胀，处于伸直位。双侧胫骨结节区域有明显畸形，可触及间隙，但无开放性皮肤伤口。他无法主动活动任何一个膝关节。未发现神经血管损伤。X线平片显示双侧胫骨结节撕脱骨折。在急诊科对骨折碎片进行了轻柔手法复位，以减轻皮肤张力。骨折碎片经手术复位并用4毫米空心螺钉从前向后固定。双下肢均置于20度屈曲的临时石膏中。术后，患者4周内不负重，然后佩戴活动范围支具并开始活动。1个月时允许完全负重，建议患者在8周前避免任何体育活动，在10周前避免接触性运动。双关节均恢复了完全活动，患者在无症状的情况下恢复了全面的体育活动。该病例强调，面对此类表现时需要高度警惕，对于进一步检查和手术干预的阈值要低。
