![]() need to identify any intra-articular involvement since this always requires anatomic reconstruction displaced grade II and III frx usually require ORIF pts usually cannot extend knee against resistance type 2B: complete tubercle frx w/ comminution type 2A: complete tubercle frx w/o comminution hence, the frx occurs thru a cartilagenous bridge between the proximal tibial physis and the tubercle apophysis tubercle epiphysis lifted anteriorly & proximally, separating tubercle ossification center as well as partially separating the non articular portion of the proximal tibial epiphysis when residual displacement is 5 mm of displacement persists adequacy of reduction can be determined by position of patella compared with that in the unaffected limb lateral radiograph of knee in full extension allows evaluation of reduction pts usually can actively extend knee - but not against resistance fragment of the tuberosity is avulsed & is displaced proximally frx through secondary ossification center type 1A: incomplete separation of fragment from metaphysis Classification (Watson Jones) & Treatment: lateral view: patella alta (degree depends on displacement of tuberosity) compartment syndrome may occur in some cases may sense a freely movable triangular fragment of bone pts may or may not be able to extend knee against resistance knee is held in 20-40 deg of flexion because of spasm of hamstrings swelling, pain, & tenderness directly over tuberosity this ossification center expands proximally & by age 17, it blends in w/ ossification center of tibial epiphysis secondary ossification centers of the proximal tibia and the tubercle merge into a bony tubercle adjacent to proximal tibial epiphysis apophyseal stage: secondary ossification center appears: in girls (8–12 years of age) and in boys (9–14 years of age) in fetus, tibial tuberosity develops from anterior aspect of proxtimal epiphysis cartilaginous stage occurs before a secondary ossification center appears in the tubercle avulsion fractures tend to occur between ages 12-16 years where as Osgood Schlatter disease involves the anteiror surface of the tubercle, the true tubercle frx is an avulsion of the apophysis need to distinguish tibial tubercle avulsion from Osgood-Schlatter disease (which has no physeal involvement) avulsion frx of tibial tuberosity along w/ a Salter Harris type-III frx of proximal tibial physis ![]()
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