Surgical management of tibial tubercle fractures in association with tibial plateau fractures fixed by direct wiring to a locking plate.

Abstract

Tibial tubercle fractures disrupting the extensor mechanism of the knee can occur in association with complex tibial plateau fractures (AO type 41A, B, C). The management of these fractures can be difficult; a stable repair of the tibial tubercle fragment is essential if the extensor mechanism is to be reconstituted. There are few reported techniques described to manage tibial tubercle fractures in conjunction with complex proximal tibial injuries. Traditionally, tibial tubercle fractures have been repaired by lagging the tubercle fragment to the posterior cortex of the tibia using 1 or more screws. However, the cortex of the posterior tibia does not always offer good purchase for screw fixation, particularly in osteopenic bone. Additionally, in complex proximal tibial fractures, comminution often extends posteriorly, further complicating stable lag screw fixation. Placement of an anteroposterior lag screw can also be complicated by "screw traffic" if there are a large number of screws fixing the primary fracture. In this article, we report a novel surgical approach for the management of tibial tubercle fracture fragments occurring in association with complex proximal tibial fractures. Using this technique, the tibial tubercle fragment is stabilized by wiring it directly to the screws of a locking plate. It allows for reduction and fixation of the tibial tubercle fragment that is stable enough to allow immediate full active range of motion. Over the past 5 years, we have applied this technique in 16 patients. Our preliminary results using this new technique have demonstrated a high rate of clinical and radiographic union with near normal return of extensor mechanism function.