Outcomes and complications of Tibial tubercle fractures in pediatric patients: A systematic review of the literature

Juan Pretell-Mazzini, Derek M. Kelly, Jeffrey R. Sawyer, Eva M.A. Esteban, David D. Spence, William C. Warner, James Beaty

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Systematic review of the literature was done to determine (1) the frequency and type of associated injuries, (2) frequency of concomitant Osgood-Schlatter disease, (3) methods of treatment, (4) functional and radiologic outcomes according to fracture type, and (5) complications of tibial tubercle fractures in pediatric patients. Methods: A systematic review of the English literature from 1970 to 2013 included 23 eligible articles reporting 336 fractures with a mean follow-up of 33.56 months (range, 5.7 to 115 mo). Fractures were classified by a comprehensive system that included characteristics of previous systems. Clinical outcomes were assessed by a qualitative scale (excellent/fair/poor), the rate of return to preinjury activity, and knee range of motion. Rate of fracture healing, associated injuries (patellar/quadriceps tendon avulsion and meniscal tears), compartment syndrome, and complications were also recorded. Results: Mean age at surgery was 14.6 years and the most common fracture reported was type III (50.6%). The overall associated injury rate was 4.1%, most common in type III fractures (4.7%). Compartment syndrome was present in 3.57% of cases. Open reduction and internal fixation were done in 98% of surgical cases. Rates of return to preinjury activity and knee range of motion were 98%, regardless of the type of fracture. Fracture consolidation was achieved in 99.4% of cases. Overall complication rate was 28.3%; removal of an implant because of bursitis (55.8%) was most common. Tenderness/prominence (17.9%) and refracture (6.3%) were also common. Conclusions: Treatment of tibial tubercle fractures in adolescents produced good clinical and radiologic results regardless of fracture type, which was more related to potential complications. Fractures with intra-articular involvement tended to present with more associated injuries and to have fair functional outcomes, suggesting that advanced imaging may be justified with these fractures. Complications could be more common than expected without a significant effect on final outcome. Finally, there is a need for longer follow-up to determine long-term outcomes.

Original languageEnglish (US)
Pages (from-to)440-446
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume36
Issue number5
DOIs
StatePublished - Jan 1 2016

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Tibial Fractures
Pediatrics
Compartment Syndromes
Wounds and Injuries
Articular Range of Motion
Knee
Osteochondrosis
Intra-Articular Fractures
Bursitis
Patellar Ligament
Fracture Healing
Tears
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Outcomes and complications of Tibial tubercle fractures in pediatric patients : A systematic review of the literature. / Pretell-Mazzini, Juan; Kelly, Derek M.; Sawyer, Jeffrey R.; Esteban, Eva M.A.; Spence, David D.; Warner, William C.; Beaty, James.

In: Journal of Pediatric Orthopaedics, Vol. 36, No. 5, 01.01.2016, p. 440-446.

Research output: Contribution to journalArticle

Pretell-Mazzini, Juan ; Kelly, Derek M. ; Sawyer, Jeffrey R. ; Esteban, Eva M.A. ; Spence, David D. ; Warner, William C. ; Beaty, James. / Outcomes and complications of Tibial tubercle fractures in pediatric patients : A systematic review of the literature. In: Journal of Pediatric Orthopaedics. 2016 ; Vol. 36, No. 5. pp. 440-446.
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abstract = "Background: Systematic review of the literature was done to determine (1) the frequency and type of associated injuries, (2) frequency of concomitant Osgood-Schlatter disease, (3) methods of treatment, (4) functional and radiologic outcomes according to fracture type, and (5) complications of tibial tubercle fractures in pediatric patients. Methods: A systematic review of the English literature from 1970 to 2013 included 23 eligible articles reporting 336 fractures with a mean follow-up of 33.56 months (range, 5.7 to 115 mo). Fractures were classified by a comprehensive system that included characteristics of previous systems. Clinical outcomes were assessed by a qualitative scale (excellent/fair/poor), the rate of return to preinjury activity, and knee range of motion. Rate of fracture healing, associated injuries (patellar/quadriceps tendon avulsion and meniscal tears), compartment syndrome, and complications were also recorded. Results: Mean age at surgery was 14.6 years and the most common fracture reported was type III (50.6{\%}). The overall associated injury rate was 4.1{\%}, most common in type III fractures (4.7{\%}). Compartment syndrome was present in 3.57{\%} of cases. Open reduction and internal fixation were done in 98{\%} of surgical cases. Rates of return to preinjury activity and knee range of motion were 98{\%}, regardless of the type of fracture. Fracture consolidation was achieved in 99.4{\%} of cases. Overall complication rate was 28.3{\%}; removal of an implant because of bursitis (55.8{\%}) was most common. Tenderness/prominence (17.9{\%}) and refracture (6.3{\%}) were also common. Conclusions: Treatment of tibial tubercle fractures in adolescents produced good clinical and radiologic results regardless of fracture type, which was more related to potential complications. Fractures with intra-articular involvement tended to present with more associated injuries and to have fair functional outcomes, suggesting that advanced imaging may be justified with these fractures. Complications could be more common than expected without a significant effect on final outcome. Finally, there is a need for longer follow-up to determine long-term outcomes.",
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AU - Pretell-Mazzini, Juan

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AU - Sawyer, Jeffrey R.

AU - Esteban, Eva M.A.

AU - Spence, David D.

AU - Warner, William C.

AU - Beaty, James

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