Epidemiology
Adolescent boys
Ossification
Proximal tibia / primary ossification centre
Tibial tuberosity / secondary ossification centre
- eventually merges with primary ossification centre
Ogden Classification
Type I - Tibial tuberosity ossification only
Type II - Extends into proximal tibial ossification centre / non articular
Type II - Extends into articular surface of proximal tibial ossification centre
Management
Beware
Compartment syndrome
Popliteal artery injury
Associated extensor mechanism disruption
- suggest ultrasound
Undisplaced
Cast in extension for 6 - 8 weeks
MUA
Indicated in type I and II +/- type III
Extend knee
- often require sedation + analgesia
- assess reduction in cast
Operative
Indications
- type I & II displaced > 5 mm
- residual recurvatum
- type III / intra-articular extension
Technique
- open reduction + AP cancellous screws through tibial tuberosity
Results
Mosier et al J Paediatr Orthop 2004
- 19 fractures
- majority from athletics / mainly basketball
- 4 reduced and immobilised, remainder required ORIF
- 3 patients had associated extensor mechanism disruption
- 2 patella tendon avulsions and 1 quadriceps tendon
Complications
Compartment syndrome
Recurvatum