Morales-Avalos Rodolfo, Martínez-Manautou Luis E, de la Garza-Castro Santiago, Pozos-Garza Alejandra J, Villarreal-Villareal Gregorio A, Peña-Martínez Víctor M, Vílchez-Cavazos Félix
Department of Orthopedic Surgery and Traumatology, University Hospital " Dr. José Eleuterio González", Universidad Autonoma de Nuevo Leon, Monterrey 66434, Nuevo Leon, Mexico.
Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 66460, Nuevo Leon, Mexico.
World J Orthop. 2020 Dec 18;11(12):615-626. doi: 10.5312/wjo.v11.i12.615.
Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases.
We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications.
This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.
文献中报道的胫骨结节撕脱骨折合并髌腱同时断裂的病例较少。因此，其机制和发病率尚未最终确定。这种类型的骨折被认为是一种严重损伤，需要及时诊断和早期手术修复。由于该损伤罕见，目前尚无治疗方案或标准治疗方法。在本病例报告中，我们对现有文献进行了详尽的综述和分析，包括所有先前报道的病例。
我们报告一名16岁男性足球运动员，在手术治疗前5天发生胫骨结节骨折并伴有髌腱远端撕脱。患者表现为膝关节伸肌机制丧失、肿胀、无法行走及疼痛。X线显示高位髌骨及胫骨结节180度撕脱。磁共振成像和计算机断层扫描确诊了该诊断。患者接受了空心螺钉和垫圈的骨折切开复位内固定以及两枚金属锚钉的髌腱修复。康复方案包括初期伸直位固定，随后进行被动活动度训练和肌肉强化锻炼。患者术后效果良好，恢复正常活动且无并发症。
本病例报告和文献综述包含了迄今为止国际文献中描述的最相关的临床、影像学和治疗细节，为读者提供了这种罕见病症的概述。
