Wood Robert, Krumrey Jacqueline, Palomino Kathryn, Hicks Megan
Orthopedics, Good Samaritan Regional Medical Center, Corvallis, USA.
Orthopedics and Traumatology, Good Samaritan Regional Medical Center, Corvallis, USA.
Cureus. 2024 Feb 22;16(2):e54696. doi: 10.7759/cureus.54696. eCollection 2024 Feb.
Tibial tubercle avulsion fractures, though rare, pose a significant challenge in pediatric orthopedics, particularly in athletic adolescents. For nondisplaced fractures, conservative treatment involves the use of braces or casts, while displaced fractures necessitate operative intervention, often through screw fixation. Concomitant soft tissue injuries should also be identified and addressed operatively to ensure complete repair of the extensor mechanism. This paper introduces a method for open reduction and internal fixation (ORIF) of tibial tubercle fractures with suture anchor repair of the distal patellar tendon avulsion. Two case examples of 14-year-old males with displaced fractures undergoing this procedure are presented. After standard screw fixation of the displaced fragment was performed, a single suture anchor was placed into the tibia and an onlay tension slide technique was utilized to secure the distal patellar tendon avulsion. Both patients underwent immobilization and protected weightbearing for four weeks with physical therapy initiated at six weeks. At four months postoperatively, both patients had returned to competitive sports without issue. The described technique may represent a reliable and reproducible method for addressing the distal patellar tendon avulsion component of tibial tubercle fractures. Its biomechanical advantages contribute to the complete repair of the extensor mechanism, enabling a successful return to competitive athletics without hardware complications.
胫骨结节撕脱骨折虽罕见，但在小儿骨科中是一项重大挑战，尤其是在青少年运动员中。对于无移位骨折，保守治疗包括使用支具或石膏，而移位骨折则需要手术干预，通常采用螺钉固定。还应识别并手术处理伴随的软组织损伤，以确保伸膝装置的完全修复。本文介绍一种胫骨结节骨折切开复位内固定（ORIF）方法，采用缝线锚钉修复髌腱远端撕脱。介绍了两名14岁男性移位骨折患者接受该手术的病例。在对移位骨折块进行标准螺钉固定后，将一枚缝线锚钉置入胫骨，并采用覆盖张力滑动技术固定髌腱远端撕脱。两名患者均固定四周并进行保护性负重，六周开始物理治疗。术后四个月，两名患者均顺利恢复竞技运动。所述技术可能是处理胫骨结节骨折髌腱远端撕脱部分的一种可靠且可重复的方法。其生物力学优势有助于伸膝装置的完全修复，使患者能成功恢复竞技运动且无内固定相关并发症。
