Agarwalla Avinesh, Puzzitiello Richard, Stone Austin V, Forsythe Brian
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
Case Rep Orthop. 2018 Aug 2;2018:1070628. doi: 10.1155/2018/1070628. eCollection 2018.
Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing failure of the physis at the patellar tendon insertion. This injury has been previously reported with various concomitant injuries, such as compartment syndrome from bleeding into the anterior compartment, vascular injury, patellar tendon avulsion, and meniscal injury-exhibited only with fracture types that extend intra-articularly. We report the case of a 14-year-old healthy adolescent male basketball player who sustained this injury as a result of a collision with another player. He initially reported to the emergency department and then presented to our practice, where he was diagnosed with a tibial tubercle avulsion fracture with patellar tendon rupture. During the operative management of these injuries, it was noted that fascial tissue avulsed through the injury site causing subacute extensive bleeding within the anterolateral compartments. Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. By five months postoperatively, the patient demonstrated near-normal function, no evidence of extensor lag, and nearly full range of motion. Unlike previously reported cases, this is the first report of a patient who suffered such an injury with multiple concomitant injuries to the neighboring structures. Due to the severity of compartment syndrome and the variability in its temporal presentation from the initial injury, it is paramount that careful evaluation of vascular integrity and a low threshold for fasciotomy be in place to prevent vascular compromise.
胫骨结节撕脱骨折是一种不常见的损伤，由于股四头肌在伸腿时强烈收缩所致，最终导致髌腱附着处的骨骺断裂。此前已有报道称，这种损伤常伴有多种合并伤，如前侧间隙出血导致的骨筋膜室综合征、血管损伤、髌腱撕脱以及半月板损伤（仅在骨折类型延伸至关节内时出现）。我们报告一例14岁健康青少年男性篮球运动员的病例，他因与另一名球员碰撞而遭受此伤。他最初前往急诊科就诊，随后转诊至我们的诊所，在那里被诊断为胫骨结节撕脱骨折伴髌腱断裂。在对这些损伤进行手术治疗时，发现筋膜组织通过损伤部位撕脱，导致前外侧间隙出现亚急性大量出血。由于担心发生骨筋膜室综合征，遂对前外侧间隙进行了筋膜切开减压术。术后五个月时，患者功能接近正常，无伸膝滞后迹象，活动范围几乎完全恢复。与先前报道的病例不同，这是首例患者遭受此类损伤并伴有邻近结构多处合并伤的报告。鉴于骨筋膜室综合征的严重性及其发生时间与初始损伤的变异性，至关重要的是要仔细评估血管完整性，并降低筋膜切开减压术的阈值，以防止血管受损。
