Tibial Tuberosity Fractures in Children

Acute fracture of the tibial tuberosity is the result of contraction of the quadriceps, resulting in a strong pull on the infrapatellar ligament in a young athlete. Usually a leaping motion is involved. On examination, there is pain and tenderness at the tibial tuberosity. There may be a knee joint effusion if the fracture extends into the knee (Salter III). Anteroposterior and lateral x-rays are used to define the fracture. The fracture may be in the plane of the growth plate (Ogden type II) or the fracture plane may be distal to the growth plate (Ogden type I) (Fig 267-1). A type III Ogden fracture extends into the knee joint. Orthopedic consultation should be obtained for these fractures, because operative reduction and fixation are often needed. Some Ogden type I injuries can be managed with a knee immobilizer and crutches. However, orthopedic follow-up is needed within 1 to 2 days.

FIG. 267-1. Ogden's classification of tibial tuberosity fractures: A. type I (fracture between secondary ossification centers), B. type II (fracture splitting secondary ossification centers from primary ossification center), and C. type III (fracture into the articular surface of the knee). From Ruiz and Cicero (1995), with permission.

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