Īnterior midline approaches are used to explore and reduce avulsed fragment, then fixation can be achieved by pins or screws, and strengthened by reparation of torn periosteum. Treatments of TTAF related in literature contrasts in line with avulsion fracture pattern: IA and IIA categories are operated within closed reduction and cast immobilization, a knee is kept in extension for 6 weeks, IIB and III AB categories are always managed surgically, then IB categories are often treated orthopedically, excepting cases of periosteum interpositions. Therefore, chronic modification of nucleus tuberosity by Osgood disease can predispose to potential acute avulsion. Otherwise, during TTAF unexpected quadriceps contraction affect deep part of proximal tibial growth cartilage. This disease happens subsequently to chronic pressure at tuberosal nucleus during teenage years producing minor tears and calcifications inside the nucleus itself. Tibial tuberosity avulsion occurs frequently in association with Osgood disease, affecting anterior part of nucleus tuberosity. Type III lesions are mostly reported in the literature (as our case). and “Y” fracture defined type 5 by McKoy and Stanitski which matches to Type IIIB coupled to Type IV fracture forming a “Y” form. Frankl et al later purposed group-C concerning fractures associated with patella ligament avulsions. Type-IV evoked by Ryu and Debenham describe avulsion fracture that extends posteriorly through the physis and may displace whole epiphysis and tubercle ( Table 1). This division was next modified by Ogden in 1980 by adding two groups A and B to designate comminution and displacement of the fragment. Type III was an avulsion that continued proximal to the physis into the knee. Type II prolonged across the physis but did not access the knee joint. Watson-Jones classification initially categorized TTAF into 3 types, Type I described an avulsion of the distal part of the tibial tubercle, distal to the proximal tibial physis. Predisposing factors comprise patella Baja, tight hamstrings, preexisting Osgood-Schlatter illness, and disorders including physeal anomalies. Tibial tubercle avulsion fracture (TTAF) is a rare condition frequently occur in adolescent male, this stage of development corresponds to the pre-ossification period, trauma mechanism is a violent contraction of quadriceps during extension when jumping or instant knee flexion opposed to quadriceps contraction during landing on the ground. School sport is not safety, 22% of teenagers could endure it.
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