Two problems can occur at the tibial tubercle. The first is the acute avulsion of the tibial tubercle; the second is the classic Osgood-Schlatter lesion. Avulsion injuries are usually incurred as an acute event during sports and play. The patient presents with the inability to walk, because of the injury, as well as with localized tenderness and swelling. The lateral radiographic view is most important because it demonstrates both the size of the fracture fragment and the degree of displacement. A minimally displaced, small avulsion fragment can be treated in a long-leg cast. Larger fragments are treated by open reduction and internal fixation. The overall prognosis is good. In contrast, Osgood-Schlatter lesions present with a vague history in adolescent boys. The pain is mild and intermittent, allowing the child to continue to participate in sports and play but not at a full level of involvement. Pain is aggravated by running, jumping, kneeling, squatting, and climbing or ascending stairs. Osgood-Schlatter disease is seen bilaterally in approximately 25 percent of the cases. In contrast to patients with avulsion injuries, patients with Osgood-Schlatter lesions experience pain with range of motion, especially range of motion against resistance, and not at rest. The treatment is symptomatic and supportive. There are minimal complications, and the prognosis is excellent.28
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