Tibial tuberosity only develops from a secondary ossification center between 10-12 year old!
Because the direction of physeal closure is from proximal to distal, this makes the tibial tuberosity more vulnerable to fracture in the adolescent (ala transitional fractures).
It only fuses by 15-17 years old!
So this injury occurs at 12-17 years old!!
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Key clinical assessment??
Anterior tibia recurrent arteryprone to be injured = 20% compartment syndrome! (Frey et al. 2008 JPO in 20 patients, 4 had compartment syndrome)
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What is the classification of tibial tuberosity Fracture?
Watson Jones Classification, modified by Ogden; Modified with A (undisplaced) and B (displaced)
Type 1 = # through 2Β° ossification centre
2 = # between 1Β° and 2Β° centers
3 = # through 1Β° center (intra-articular)
4 = Through entire proximal physis
5 = apophyseal avulsion of tibia tuberosity
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How do you fix this?
Use 4mm partially threaded canulated screws
I will hyperextend the knee by putting a bolster under the calf
Direct longitudinal incision over fracture, remove interposed perosteum, reduce and pass guidewires from Anterior to posterior while avoiding the physis,
Post op flex the knee to 90 Β° to screen
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What potential complication?
Recurvatum (growth arrest of secondary ossification center) β Do epiphysiodesis to complete growth shut down KIV corrective opening wedge osteotomy