UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric Tibial tubercle avulsion fractures

Keywords: Orthopedics, compartment syndrome (PubMed Search)

Posted: 9/20/2019 by Jenny Guyther, MD (Updated: 10/14/2019)
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-       Tibial tubercle avulsion fractures are rare and pediatrics, accounting for less than 3% of all epiphyseal injuries in children ages 11-17 years. 

-       The typical mechanism is a sudden forceful quadriceps contraction.  Patients present with sudden pain after sprinting or jumping with pain, bruising, deformity or swelling over the tibial tubercle and with a decrease ability to extend the leg. 

-       10 to 20% of cases result in anterior compartment syndrome related to the rupture of the anterior tibial recurrent artery.

-       Although directly measured intra-compartmental pressures can facilitate the diagnosis of compartment syndrome, interpretation of these values can be challenging with healthy children having higher average lower leg compartment pressures than adults.  Treatment of subsequent compartment syndrome is often based on a high index of suspicion.

References

Yue et al.  Bilateral tibial tubercle avulsion fractures: Pediatric orthopedic injury at high risk for compartment syndrome.  The American Journal of Emergency Medicine.  Available online May 2019.