A Rare Case of Bilateral Tibial Tuberosity Avulsion in an Adolescent Male

Nova Southeastern University, Davie, Florida, USA

Introduction. Tibial tubercle fractures are rare, with one bilateral tubercle fracture reported among 21 case reports. Case presentation: A 14-year old Latino male arrived from a trampoline park with bilateral knee pain after landing with his knees in flexion. Physical exam demonstrated an overweight adolescent male with marked swelling and tenderness of his knees, unable to tolerate passive range of motion from a flexed position. The compartments remained soft, with sensation and pulses intact. Orthopedics emergently admitted the patient to the operating room where closed reduction under fluoroscopy was performed. The patient returned to the OR for open reduction and internal fixation to optimize approximation and was discharged a few days later. Deviation From the Expected This is the first reported bilateral tibial tuberosity fracture that extends to the posterior cortex. Discussion A simple avulsion fracture of the tibial tuberosity represents less than 1% of pediatric fractures, with only 21 bilateral fractures reported in published case reports. The injury is most common in males age 12-15 and occur at the ossification center. Treatment generally requires open reduction and internal fixation. Outcomes are good with frequent return to full activity. Given the marked swelling ED management must be focused on compartment syndrome. Conclusion Tibial tubercle fractures are rare, with this case representing the first bilateral tubercle fracture with extension to the posterior cortex being reported in the literature. The diagnosis is imperative to ensure definitive treatment, optimal range of motion, and reduction of the fracture at the growth plate.