Peez Christian, Zderic Ivan, Richards R Geoff, Drenchev Ludmil, Skulev Hristo K, Gueorguiev Boyko, Kittl Christoph, Raschke Michael J, Herbst Elmar
Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
AO Research Institute, Davos, Switzerland.
Eur J Trauma Emerg Surg. 2025 Mar 18;51(1):136. doi: 10.1007/s00068-025-02814-w.
Current literature lacks recommendations regarding proper fixation of tibial tubercle avulsion fractures involving the proximal tibial epiphysis (Ogden fractures). Therefore, the aim of this study was to compare isolated apophyseal screw fixation and additional fixation techniques in Ogden fractures.
Two different types of apoepiphyseal tibial tubercle avulsion fractures were created in 40 proximal tibiae according to the modified Ogden classification: (1) Ogden type IIIA and (2) Ogden type IV. The fractures were fixed with either isolated apophyseal screws or additionally with a medial plate or epiphyseal screws. All specimens were biomechanically tested under progressively increasing cyclic loading until failure, while capturing the interfragmentary movements with motion tracking.
Augmentation of apophyseal screw osteosynthesis by a medial plate in Ogden IV fractures or epiphyseal screws in Ogden IIIA fractures exhibited significantly higher cycles to failure and failure loads (P< 0.05), and significantly less axial displacement (P < 0.05) compared to isolated apophyseal screw fixation. Fixation of Ogden type IIIA fractures resulted in significantly less axial displacements and higher construct stiffness, cycles to failure and failure loads compared to Ogden type IV fracture (P < 0.001). Fracture gap opening did not differ significantly between the fixation techniques.
Augmented apophyseal screw fixation of apoepiphyseal tibial tubercle avulsion fractures provides greater biomechanical stability than isolated apophyseal screw fixation. Regardless of fixation technique, Ogden type IV fractures are more unstable than Ogden type IIIA fractures, so an individualized treatment strategy based on fracture morphology is crucial. In case of an Ogden type IIIA or Ogden type IV fracture, surgeons should consider adding epiphyseal screws or a medial plate osteosynthesis to apophyseal screw fixation to best neutralize forces of the extensor mechanism, as long as the often compromised soft tissue envelope can tolerate greater surgical invasiveness.
目前的文献缺乏关于涉及胫骨近端骨骺的胫骨结节撕脱骨折（奥格登骨折）正确固定方法的建议。因此，本研究的目的是比较奥格登骨折中单纯骨骺螺钉固定和附加固定技术。
根据改良的奥格登分类法，在40个胫骨近端制造两种不同类型的骨骺-骨骺间胫骨结节撕脱骨折：（1）奥格登III A型和（2）奥格登IV型。骨折采用单纯骨骺螺钉固定，或附加内侧钢板或骨骺螺钉固定。所有标本在逐渐增加的循环载荷下进行生物力学测试，直至失效，同时用运动跟踪记录骨折块间的运动。
与单纯骨骺螺钉固定相比，在奥格登IV型骨折中用内侧钢板增强骨骺螺钉骨合成，或在奥格登III A型骨折中用骨骺螺钉增强，均表现出显著更高的失效循环数和失效载荷（P<0.05），以及显著更小的轴向位移（P<0.05）。与奥格登IV型骨折相比，奥格登III A型骨折的固定导致显著更小的轴向位移和更高的结构刚度、失效循环数和失效载荷（P<0.001）。不同固定技术之间的骨折间隙开口无显著差异。
骨骺-骨骺间胫骨结节撕脱骨折的增强骨骺螺钉固定比单纯骨骺螺钉固定提供更大的生物力学稳定性。无论固定技术如何，奥格登IV型骨折比奥格登III A型骨折更不稳定，因此基于骨折形态的个体化治疗策略至关重要。对于奥格登III A型或奥格登IV型骨折，外科医生应考虑在骨骺螺钉固定的基础上增加骨骺螺钉或内侧钢板骨合成，以最佳地抵消伸肌机制的力量，只要通常受损的软组织包膜能够耐受更大的手术侵袭性。
