title: Tibial tubercle fractures in children with intra-articular involvement: surgical tips for technical ease.
abstract: BACKGROUND
  Tibial tubercle fractures often occur in athletic adolescents close to skeletal maturity. These fractures can present with marked displacement of the apophysis, intra-articular extension, and associated soft tissue injuries, such as tibial meniscal ligament tears. Here, we present our surgical technique which focuses on recreating the meniscal-articular relationship (using suture anchors) in severely displaced fractures.
  
  
  METHODS
  We retrospectively reviewed all tibial tuberosity fractures treated with this technique over the last 2.5 years. Fractures with a minimum of a 12-month follow-up post-fixation were identified. Clinical records and radiographs were reviewed. Data included patient age, gender, involved side, injury classification (modified Ogden), mechanism of injury, treatment, return to activity, and complications.
  
  
  RESULTS
  Six patients met the inclusion criteria. Mean age at time of surgery was 14.9 (range 13.2-16.8) years. All patients were male and the mean follow-up period was 14 (12-26) months. Range of motion was started at 4 weeks post-operatively in a hinged knee brace, and return to sports occurred at an average of 3.75 months postoperatively (range 3-5 months). No evidence of growth disturbance of the proximal tibia or recurvatum at final follow-up was evident.
  
  
  CONCLUSIONS
  We speculate that patients who sustain a tibial tubercle avulsion fracture types III or V will likely have intra-articular pathology, specifically capsular avulsion or coronary ligament disruption. By utilizing suture anchors, our technique emphasizes renewing the anatomic articular environment to ensure better long-term results and maintaining these active individuals in sports.
authors.affiliation: San Antonio Military Medical Center, Brooke Army Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234-6200 USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Howarth
authors.forename: Hilton P
authors.initials: HP
authors.lastname: Gottschalk
authors.forename: Harish S
authors.initials: HS
authors.lastname: Hosalkar