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Spanning external fixator application
1%
15/2652
Open reduction and internal fixation
77%
2036/2652
Percutaneous pinning w multiple cannulated screws
21%
552/2652
Patellar tendon repair with allograft patch
0%
12/2652
Hinged knee brace locked at 10 degrees flexion
26/2652
Select Answer to see Preferred Response
This patient has a tibial tubercle fracture with extension to the articular surface, this is best treated with ORIF, with an arthrotomy as needed. Tibial tubercle fractures are most common in adolescent males after violent contraction of the quadriceps mechanism, typically in an athletic setting. Injury can be limited to the tubercle apophysis or involve the proximal tibial physis. While significant vascular injuries to the popliteal or posterior tibial arterial branches can occur with tibial physis injuries, the recurrent branch of the anterior tibial artery may also be injured in apophysis injuries and cause anterior compartment syndrome. Given the fracture pattern and displacement, arthrotomy to visualize the articular surface can aid in reduction prior to fixation. Pretell-Mazzini et al. performed a systematic review of tibial tubercle fractures. The most common injuries were Ogden type III fractures, and 88% of all fractures were treated operatively with an overall 99.4% union rate. There was a 28% complication rate, with symptomatic hardware being most common. Overall this study demonstrates excellent outcomes for these fractures with few long-term extensor mechanism issues. Jakoi et al. reviewed a case series of adolescent tibial tubercle fractures treated surgically and rates of return to basketball. They found all patients were able to return to play by 9 months postop, with all the open reduction internal fixation cases achieving union. Figure A shows an sagittal CT with the knee and demonstrates an Ogden type 3 tibial tubercle fracture. Illustration A depicts the mechanism of injury of tibial tubercle fractures. Illustration B shows the Ogden classification. Incorrect Answers: Answer 1- This may be an option as a temporizing measure but not for definitive treatment of these fractures Answer 3- Open reduction is preferred to achieve anatomic alignment and to address associated injuries such as the patellar tendon. Answer 4- The patellar tendon is intact and is deforming the fracture pattern Answer 5- This fracture needs to be anatomically reduced given the amount of displacement and involvement of the articular surface
2.0
(3)
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