SlideShare a Scribd company logo
Robert ELBAUM 
Clinique Edith Cavell, Brussels, 
Erasme Universitary Hospital 
Belgium
 Avulsion-fracture of the anterior tibial tubercle (ATT) 
occurs in adolescents, predominantly male. 
 Avulsion fracture of the ATT represents 3% of all 
injuries of the proximal tibia and 0.4 to 2.4% of all 
epiphyseal fractures . 
 From 1853 till now, more than 250 cases have been 
reported in the literature.
 Simultaneous bilateral avulsion fractures of the tibial tubercle 
are very uncommon. 
 Since the first description by Borsch-Madsen in 1955 , 
15 cases have been reported. Associated patellar ligament 
avulsion is also uncommon . 
 We report another bilateral case featuring these two rare 
injuries. 
 We will also discuss the appropriate classification, the 
aetiopathogenenesis of this injury and the proposed 
treatment.
 a 16-year old boy 
 Following a jump on both 
feet. 
 2 swollen knees and a 
marked tenderness over the 
tibial tubercles. 
 Active extension was 
impossible bilaterally. 
 X-Ray :bilateral avulsion 
fracture of the tibial 
tubercle, type 3A according 
to Ogden’s classification.
 L knee: complete avulsion of the 
tibial tuberosity with an intact 
patellar ligament. 
R knee: partial disruption of the 
patellar ligament 
 the fragments were reduced and 
fixed with two cannulated 
screws. The right patellar 
ligament was repaired.
 Six months later the 
cannulated screws were 
removed in one day 
surgery. 
 1Y FU: no pain, no 
functional limitation and 
had resumed his sporting 
activity (judo). 
 X-Ray :complete 
remodeling of the tibial 
tubercle.
WATSON-JONES (1976) OGDEN (1980) 
type I: avulsion fracture of the distal part of 
the tibial tubercle; 
type II: displacement of the lip of the 
anterior part of the tibial epiphysis. 
type III :fracture of the base of the lip with 
propagation into the knee joint. 
3 subgroups A or B, with a possible 
intra-articular extension of the fracture 
as well as comminution of the fragment
 In 1990, Frankl described two cases of ATT 
avulsion-fracture associated with avulsion of the 
patellar ligament. He proposed an addition to 
the classification to include avulsion of the 
patellar ligament (Type I-C). 
 Ryu and Debenham subsequently added a 
fourth type corresponding to an extension of the 
fracture to the posterior cortex through the 
growth plate (Salter Harris type 2).
 The tibial tubercle physis 
is in continuity with that 
of the tibial plateau. The 
physis progressively fuses 
from posterior to 
anterior, making it most 
vulnerable to avulsion in 
adolescents aged 13-16 
years.
 During take-off or a jump, 
the quadriceps mechanism 
forcefully contracts against 
the patellar tendon 
insertion. When the force 
exceeds the strength of the 
tibial tubercle physis, a 
fracture is generated, 
leading to avulsion of the 
tibial tubercle.
 Indirect force caused by sudden 
contraction of the quadriceps 
muscle. 
 Acute passive flexion of the knee 
against a contracting quadriceps, 
such as landing after a jump (as in 
our case) is another mechanism of 
injury
 Osgood Schlatter 
 patella infera 
 tight hamstrings 
 disorders involving physeal abnormalities. 
 …
Avulsion simultanée bilatérale tubérosité tibiale antérieure
AUTHORS YEAR SEX AGE N Classification Circonstance Mechanism simultaneity TR last FU 
BORCH-MADSEN 1954 M 17 1 W-J TYPEIII ORIF 
OGDEN and coll 1980 M 14 1 W-J TYPEIII ORIF 
HENRARD et coll 1983 M 1 ORIF 
MAAR et coll 1988 M 16A 1 W-J TYPE III Basketball jump YES ORIF 3Y 
LEPSE et coll 1988 M 14A 1 W-J TYPE III Gymnast forward flip YES ORIF 1Y 
INOUE et coll 1991 M 16Y 1 W-J Type IV 
SIEBERT et coll 1995 M 16A 1 OGDEN 1B L 
+SALTER 2 R 
Athletism Starting YES ORIF 20W 
MIRLY and coll 1996 M 
MOSIER et coll 2000 M 15Y 1 OGDEN IIIB+ IV YES 
ERGUN et coll 2003 M 16Y 1 OGDEN 2B Bilat Basketball landing 
after 
forcefull 
jump 
YES ORIF 27M 
HAMILTON et coll 2006 M 13Y 1 TYPE I R+TYPE II L Soccer jump YES ORIF 
SLOBOGEAN et coll 2006 M 16Y 1 TYPE IV L+TYPE III 
R 
Running sudden stop YES L:Closed 
reduction 
R:ORIF 
1Y 6M 
GEORGIOU et coll 2007 M 17Y 1 W-J TYPE III Sport jump YES ORIF 
NEUGBAUER et coll 2007 M 16Y 1 OGDEN 3A bilat Gymnast jump YES ORIF 
ARREDONDO-GOMEZ 
et coll 
2007 M 14Y 1 OGDEN3 A R 
+OGDEN 3B G 
Soccer Indirect YES ORIF 
SCHAFFER et coll 2008 M 13Y 1 SALTER 2 R+ 
SALTER 3 L 
Long Jump take off and 
landing 
YES ORIF
 Male,13 - 17 y ,close to skeletal maturity. 
 Causal mechanism :sudden jump with a landing on the 
ground while contracting the quadriceps muscle. 
 According to the Watson-Jones and Ogden 
classifications, most cases were type IIIA or B. 
 The type III fractures involving a growth plate and 
extending through the articular surface, appear to do 
well following open reduction and internal fixation 
despite their bilateral nature. 
 No report of growth disturbance of the proximal tibial 
epiphysis after that type of injury.
 Recommandation for type III fracture: CT scan to 
evaluate the intraarticular surface. 
 Accurate diagnosis of the lesion is important to 
determine the appropriate treatment in order to 
avoid malfunction of the extensor mechanism of 
the knee in case of avulsion of the patellar 
ligament (type 1-C). 
 Open reduction with internal fixation (screw, 
wiring or K-wire) has been the common treatment 
for this type of lesion.
 Bilateral simultaneous avulsion fracture of the 
anterior tibial tubercle (ATT) are extremely rare. 
 We believe that treatment should always include 
open reduction and internal fixation for all type II 
or III lesions. 
 It appears from the literature that the recovery 
and functional outcome of bilateral injuries is 
comparable to those of unilateral tibial tubercle 
avulsion fractures: results have been good to 
excellent in most of the cases.
Avulsion simultanée bilatérale tubérosité tibiale antérieure

More Related Content

What's hot

Triple arthrodesis
Triple arthrodesisTriple arthrodesis
Triple arthrodesis
Ponnilavan Ponz
 
Metatarsus adductus
Metatarsus adductusMetatarsus adductus
Metatarsus adductus
RziUllah
 
Full Endoscopic Lumbar Discectomy
Full Endoscopic Lumbar Discectomy Full Endoscopic Lumbar Discectomy
Full Endoscopic Lumbar Discectomy
Reza Aminnejad
 
Final final madhu sir
Final final  madhu sirFinal final  madhu sir
Final final madhu sir
varuntandra
 
The pathology and management of blount’s disease
The pathology and management of blount’s diseaseThe pathology and management of blount’s disease
The pathology and management of blount’s disease
Asi-oqua Bassey
 
Cavus foot
Cavus footCavus foot
Cavus foot
Dr. Anurag Mittal
 
RADIAL NERVE PALSY AND TENDON TRANSFER
RADIAL NERVE PALSY AND TENDON TRANSFERRADIAL NERVE PALSY AND TENDON TRANSFER
RADIAL NERVE PALSY AND TENDON TRANSFER
Benthungo Tungoe
 
Lisfranc injury
Lisfranc injuryLisfranc injury
Lisfranc injury
Dr Sharanprasad Hongal
 
Post polio residual paralysis of foot and ankle
Post polio residual paralysis of foot and anklePost polio residual paralysis of foot and ankle
Post polio residual paralysis of foot and ankle
GIRIDHAR BOYAPATI
 
Elbow instability
Elbow instabilityElbow instability
Elbow instability
Ayush Arora
 
arthrodesis
 arthrodesis arthrodesis
arthrodesis
Harjot Gurudatta
 
Bone tumours and principles of limb salvage surgery
Bone tumours and principles of limb salvage surgeryBone tumours and principles of limb salvage surgery
Bone tumours and principles of limb salvage surgery
Paudel Sushil
 
MEDIAN NERVE PALSY AND TENDON TRANSFERS
MEDIAN NERVE PALSY AND TENDON TRANSFERSMEDIAN NERVE PALSY AND TENDON TRANSFERS
MEDIAN NERVE PALSY AND TENDON TRANSFERS
Benthungo Tungoe
 
Stiff elbow
Stiff elbowStiff elbow
Stiff elbow
Paudel Sushil
 
Equinus
EquinusEquinus
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANI
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANICURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANI
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANI
Girish Motwani
 
Perilunate dislocations
Perilunate dislocationsPerilunate dislocations
Perilunate dislocations
Rashik Ismail
 
Hip osteotomy
Hip osteotomyHip osteotomy
Hip osteotomy
orthoprince
 
Achilles Tendon Lengthening.pptx
Achilles Tendon Lengthening.pptxAchilles Tendon Lengthening.pptx
Achilles Tendon Lengthening.pptx
AhmadSyaukat2
 

What's hot (20)

Triple arthrodesis
Triple arthrodesisTriple arthrodesis
Triple arthrodesis
 
Metatarsus adductus
Metatarsus adductusMetatarsus adductus
Metatarsus adductus
 
Full Endoscopic Lumbar Discectomy
Full Endoscopic Lumbar Discectomy Full Endoscopic Lumbar Discectomy
Full Endoscopic Lumbar Discectomy
 
Cast syndrome
Cast syndromeCast syndrome
Cast syndrome
 
Final final madhu sir
Final final  madhu sirFinal final  madhu sir
Final final madhu sir
 
The pathology and management of blount’s disease
The pathology and management of blount’s diseaseThe pathology and management of blount’s disease
The pathology and management of blount’s disease
 
Cavus foot
Cavus footCavus foot
Cavus foot
 
RADIAL NERVE PALSY AND TENDON TRANSFER
RADIAL NERVE PALSY AND TENDON TRANSFERRADIAL NERVE PALSY AND TENDON TRANSFER
RADIAL NERVE PALSY AND TENDON TRANSFER
 
Lisfranc injury
Lisfranc injuryLisfranc injury
Lisfranc injury
 
Post polio residual paralysis of foot and ankle
Post polio residual paralysis of foot and anklePost polio residual paralysis of foot and ankle
Post polio residual paralysis of foot and ankle
 
Elbow instability
Elbow instabilityElbow instability
Elbow instability
 
arthrodesis
 arthrodesis arthrodesis
arthrodesis
 
Bone tumours and principles of limb salvage surgery
Bone tumours and principles of limb salvage surgeryBone tumours and principles of limb salvage surgery
Bone tumours and principles of limb salvage surgery
 
MEDIAN NERVE PALSY AND TENDON TRANSFERS
MEDIAN NERVE PALSY AND TENDON TRANSFERSMEDIAN NERVE PALSY AND TENDON TRANSFERS
MEDIAN NERVE PALSY AND TENDON TRANSFERS
 
Stiff elbow
Stiff elbowStiff elbow
Stiff elbow
 
Equinus
EquinusEquinus
Equinus
 
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANI
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANICURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANI
CURRENT TRENDS IN MANAGEMENT OF PERTHES DISEASE BY DR.GIRISH MOTWANI
 
Perilunate dislocations
Perilunate dislocationsPerilunate dislocations
Perilunate dislocations
 
Hip osteotomy
Hip osteotomyHip osteotomy
Hip osteotomy
 
Achilles Tendon Lengthening.pptx
Achilles Tendon Lengthening.pptxAchilles Tendon Lengthening.pptx
Achilles Tendon Lengthening.pptx
 

Viewers also liked

MULLER AO CLASSIFICATION
MULLER AO CLASSIFICATIONMULLER AO CLASSIFICATION
MULLER AO CLASSIFICATION
inks76
 
Emily challinor evaluation questions
Emily challinor evaluation questionsEmily challinor evaluation questions
Emily challinor evaluation questions
EmilyChallinor101
 
Social media marketing for small business
Social media marketing for small businessSocial media marketing for small business
Social media marketing for small business
Charmaine Xy-Za Yape
 
Effective Emailing
Effective EmailingEffective Emailing
Effective Emailing
AndyatELC
 
070107 David Getting His Sheepskin
070107 David   Getting His Sheepskin070107 David   Getting His Sheepskin
070107 David Getting His Sheepskin
Dale Wells
 
Austin's Nine Characteristics of Life
Austin's Nine Characteristics of LifeAustin's Nine Characteristics of Life
Austin's Nine Characteristics of Life
guestf6b7ed
 
FENOMENUL LEGIONAR
FENOMENUL LEGIONARFENOMENUL LEGIONAR
FENOMENUL LEGIONAR
LauraDwaine
 
Resultats del qüestionari
Resultats del qüestionariResultats del qüestionari
Resultats del qüestionari
acolome7
 
Evaluacion plataformas v
Evaluacion plataformas vEvaluacion plataformas v
Evaluacion plataformas v
Saida Patricia Calderón Corzo
 
Herald_Summer 2015
Herald_Summer 2015Herald_Summer 2015
Herald_Summer 2015
Kimberly Duffield
 
TapSnap Partner Program Introduction
TapSnap Partner Program IntroductionTapSnap Partner Program Introduction
TapSnap Partner Program Introduction
TapSnap
 
Digital Folio
Digital FolioDigital Folio
Digital Folio
SenStudio Inc
 
Training intro to death
Training intro to deathTraining intro to death
Training intro to death
Susan Lanford
 
Plataforma cifra
Plataforma cifraPlataforma cifra
Plataforma cifra
maitpra
 
Pedro henry sáenz jiménez actividad1_2mapac
Pedro henry sáenz jiménez actividad1_2mapacPedro henry sáenz jiménez actividad1_2mapac
Pedro henry sáenz jiménez actividad1_2mapac
Pedro Henry Sáenz Jiménez
 
No metalica
No metalicaNo metalica
No metalica
ivan chavez soto
 
Gwladys Hall Ltd.
Gwladys Hall Ltd.Gwladys Hall Ltd.
Gwladys Hall Ltd.
Gwladys HALL
 
Kathleen ed tech
Kathleen ed techKathleen ed tech
Kathleen ed tech
Kathleen Bantigue
 
ReferBoost
ReferBoostReferBoost
ReferBoost
Matthew Hartman
 

Viewers also liked (20)

MULLER AO CLASSIFICATION
MULLER AO CLASSIFICATIONMULLER AO CLASSIFICATION
MULLER AO CLASSIFICATION
 
Emily challinor evaluation questions
Emily challinor evaluation questionsEmily challinor evaluation questions
Emily challinor evaluation questions
 
Social media marketing for small business
Social media marketing for small businessSocial media marketing for small business
Social media marketing for small business
 
Effective Emailing
Effective EmailingEffective Emailing
Effective Emailing
 
070107 David Getting His Sheepskin
070107 David   Getting His Sheepskin070107 David   Getting His Sheepskin
070107 David Getting His Sheepskin
 
Austin's Nine Characteristics of Life
Austin's Nine Characteristics of LifeAustin's Nine Characteristics of Life
Austin's Nine Characteristics of Life
 
FENOMENUL LEGIONAR
FENOMENUL LEGIONARFENOMENUL LEGIONAR
FENOMENUL LEGIONAR
 
Resultats del qüestionari
Resultats del qüestionariResultats del qüestionari
Resultats del qüestionari
 
Evaluacion plataformas v
Evaluacion plataformas vEvaluacion plataformas v
Evaluacion plataformas v
 
Herald_Summer 2015
Herald_Summer 2015Herald_Summer 2015
Herald_Summer 2015
 
TapSnap Partner Program Introduction
TapSnap Partner Program IntroductionTapSnap Partner Program Introduction
TapSnap Partner Program Introduction
 
Digital Folio
Digital FolioDigital Folio
Digital Folio
 
Training intro to death
Training intro to deathTraining intro to death
Training intro to death
 
44
4444
44
 
Plataforma cifra
Plataforma cifraPlataforma cifra
Plataforma cifra
 
Pedro henry sáenz jiménez actividad1_2mapac
Pedro henry sáenz jiménez actividad1_2mapacPedro henry sáenz jiménez actividad1_2mapac
Pedro henry sáenz jiménez actividad1_2mapac
 
No metalica
No metalicaNo metalica
No metalica
 
Gwladys Hall Ltd.
Gwladys Hall Ltd.Gwladys Hall Ltd.
Gwladys Hall Ltd.
 
Kathleen ed tech
Kathleen ed techKathleen ed tech
Kathleen ed tech
 
ReferBoost
ReferBoostReferBoost
ReferBoost
 

Similar to Avulsion simultanée bilatérale tubérosité tibiale antérieure

Distal radius fracture
Distal radius fractureDistal radius fracture
Distal radius fracture
Barun Patel
 
Ankle And Foot
Ankle And FootAnkle And Foot
Ankle And Foot
EM OMSB
 
Lisfranc injury
Lisfranc injuryLisfranc injury
Lisfranc injury
Subodh Pathak
 
Mid foot lisfranc fracture
Mid foot lisfranc fractureMid foot lisfranc fracture
Mid foot lisfranc fracture
Abhishek Sachdev
 
Lisfranc injuries
Lisfranc injuriesLisfranc injuries
Lisfranc injuries
Anshul Sethi
 
ACMCR-v3-1195.pdf
ACMCR-v3-1195.pdfACMCR-v3-1195.pdf
ACMCR-v3-1195.pdf
SarkarRenon
 
Dr Deepak Chahar Hip Dislocation JCOT
Dr Deepak Chahar Hip Dislocation JCOTDr Deepak Chahar Hip Dislocation JCOT
Dr Deepak Chahar Hip Dislocation JCOT
Deepak Chahar
 
Lisfranc injury-
Lisfranc injury- Lisfranc injury-
Lisfranc injury-
Chandramani Roy
 
Pilon fractures
Pilon fracturesPilon fractures
Pilon fractures
Dr Imran Jan
 
Ganyang MCQ Ortho Answers
Ganyang MCQ Ortho AnswersGanyang MCQ Ortho Answers
Ganyang MCQ Ortho Answers
Kirie Kozanegawa
 
Fractures.pptx
Fractures.pptxFractures.pptx
Fractures.pptx
JaneBwalya1
 
Orthopedics
OrthopedicsOrthopedics
Orthopedics
Lih Yin Chong
 
fracture It femur
fracture It femurfracture It femur
fracture It femur
Mahak Jain
 
BIMALLEOLAR FRACTURES mechanism and anapath.pptx
BIMALLEOLAR FRACTURES mechanism and anapath.pptxBIMALLEOLAR FRACTURES mechanism and anapath.pptx
BIMALLEOLAR FRACTURES mechanism and anapath.pptx
WailAggoun
 
The area known as lisfranc
The area known as lisfrancThe area known as lisfranc
The area known as lisfranc
Moosa Mohideen
 
Fracture neck of femur
Fracture neck of  femurFracture neck of  femur
Fracture neck of femur
Prateek Singh
 
Anterior cruciate ligament_injury_in_indoor_ball_games
Anterior cruciate ligament_injury_in_indoor_ball_gamesAnterior cruciate ligament_injury_in_indoor_ball_games
Anterior cruciate ligament_injury_in_indoor_ball_games
Алькасар Медиа Сервис
 
Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)
College of Medicine, Sulaymaniyah
 
Radiological Investigations of spinal Trauma.pptx
Radiological Investigations of spinal Trauma.pptxRadiological Investigations of spinal Trauma.pptx
Radiological Investigations of spinal Trauma.pptx
ssusere6b07d
 
2016.01.26, EC Neuro Proof
2016.01.26, EC Neuro Proof2016.01.26, EC Neuro Proof
2016.01.26, EC Neuro Proof
Robert Lieberson, MD, FAANS, FACS
 

Similar to Avulsion simultanée bilatérale tubérosité tibiale antérieure (20)

Distal radius fracture
Distal radius fractureDistal radius fracture
Distal radius fracture
 
Ankle And Foot
Ankle And FootAnkle And Foot
Ankle And Foot
 
Lisfranc injury
Lisfranc injuryLisfranc injury
Lisfranc injury
 
Mid foot lisfranc fracture
Mid foot lisfranc fractureMid foot lisfranc fracture
Mid foot lisfranc fracture
 
Lisfranc injuries
Lisfranc injuriesLisfranc injuries
Lisfranc injuries
 
ACMCR-v3-1195.pdf
ACMCR-v3-1195.pdfACMCR-v3-1195.pdf
ACMCR-v3-1195.pdf
 
Dr Deepak Chahar Hip Dislocation JCOT
Dr Deepak Chahar Hip Dislocation JCOTDr Deepak Chahar Hip Dislocation JCOT
Dr Deepak Chahar Hip Dislocation JCOT
 
Lisfranc injury-
Lisfranc injury- Lisfranc injury-
Lisfranc injury-
 
Pilon fractures
Pilon fracturesPilon fractures
Pilon fractures
 
Ganyang MCQ Ortho Answers
Ganyang MCQ Ortho AnswersGanyang MCQ Ortho Answers
Ganyang MCQ Ortho Answers
 
Fractures.pptx
Fractures.pptxFractures.pptx
Fractures.pptx
 
Orthopedics
OrthopedicsOrthopedics
Orthopedics
 
fracture It femur
fracture It femurfracture It femur
fracture It femur
 
BIMALLEOLAR FRACTURES mechanism and anapath.pptx
BIMALLEOLAR FRACTURES mechanism and anapath.pptxBIMALLEOLAR FRACTURES mechanism and anapath.pptx
BIMALLEOLAR FRACTURES mechanism and anapath.pptx
 
The area known as lisfranc
The area known as lisfrancThe area known as lisfranc
The area known as lisfranc
 
Fracture neck of femur
Fracture neck of  femurFracture neck of  femur
Fracture neck of femur
 
Anterior cruciate ligament_injury_in_indoor_ball_games
Anterior cruciate ligament_injury_in_indoor_ball_gamesAnterior cruciate ligament_injury_in_indoor_ball_games
Anterior cruciate ligament_injury_in_indoor_ball_games
 
Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 7th/part two & 8th lectures (Dr. Ali A.Nabi)
 
Radiological Investigations of spinal Trauma.pptx
Radiological Investigations of spinal Trauma.pptxRadiological Investigations of spinal Trauma.pptx
Radiological Investigations of spinal Trauma.pptx
 
2016.01.26, EC Neuro Proof
2016.01.26, EC Neuro Proof2016.01.26, EC Neuro Proof
2016.01.26, EC Neuro Proof
 

More from ROBERT ELBAUM

Troubles statiques et rotationnels des membres inferieurs
Troubles statiques et rotationnels des membres inferieursTroubles statiques et rotationnels des membres inferieurs
Troubles statiques et rotationnels des membres inferieurs
ROBERT ELBAUM
 
Posttraumatic radio ulnar synostosis
Posttraumatic radio ulnar synostosis   Posttraumatic radio ulnar synostosis
Posttraumatic radio ulnar synostosis
ROBERT ELBAUM
 
French Functional Method for Congenital Clubfoot: 20 years of experience
French Functional Method for Congenital Clubfoot: 20 years of experienceFrench Functional Method for Congenital Clubfoot: 20 years of experience
French Functional Method for Congenital Clubfoot: 20 years of experience
ROBERT ELBAUM
 
Les boiteries chez l'enfant
Les boiteries chez l'enfantLes boiteries chez l'enfant
Les boiteries chez l'enfant
ROBERT ELBAUM
 
La luxation congenitale de la hanche
La luxation congenitale de la hancheLa luxation congenitale de la hanche
La luxation congenitale de la hanche
ROBERT ELBAUM
 
Orthopaedic support with 3D printing in children
Orthopaedic support with 3D printing in childrenOrthopaedic support with 3D printing in children
Orthopaedic support with 3D printing in children
ROBERT ELBAUM
 
Digitized manual palpation: a new method of evaluating posture and its defor...
 Digitized manual palpation: a new method of evaluating posture and its defor... Digitized manual palpation: a new method of evaluating posture and its defor...
Digitized manual palpation: a new method of evaluating posture and its defor...
ROBERT ELBAUM
 
Knee osteochondritis and platelet rich plasma
Knee osteochondritis and platelet  rich plasmaKnee osteochondritis and platelet  rich plasma
Knee osteochondritis and platelet rich plasma
ROBERT ELBAUM
 
Aspect particulier en traumatologie pédiatrique
Aspect particulier en traumatologie pédiatriqueAspect particulier en traumatologie pédiatrique
Aspect particulier en traumatologie pédiatrique
ROBERT ELBAUM
 
Fractures in Children: Is conservative treatment still alive?
Fractures in Children: Is conservative treatment still alive?Fractures in Children: Is conservative treatment still alive?
Fractures in Children: Is conservative treatment still alive?
ROBERT ELBAUM
 
L'embrochage centromédullaire élastique stable (ECMES) chez l'enfant
L'embrochage centromédullaire élastique stable (ECMES) chez l'enfantL'embrochage centromédullaire élastique stable (ECMES) chez l'enfant
L'embrochage centromédullaire élastique stable (ECMES) chez l'enfant
ROBERT ELBAUM
 
Le torticoli congenital: Musculaire ou Postural?
Le torticoli congenital: Musculaire ou Postural?Le torticoli congenital: Musculaire ou Postural?
Le torticoli congenital: Musculaire ou Postural?
ROBERT ELBAUM
 
Spondylolyse chez l'enfant
Spondylolyse chez l'enfant Spondylolyse chez l'enfant
Spondylolyse chez l'enfant
ROBERT ELBAUM
 
Congenital Hallux varus: How to deal with it?
Congenital Hallux varus: How to deal with it?Congenital Hallux varus: How to deal with it?
Congenital Hallux varus: How to deal with it?
ROBERT ELBAUM
 
Osteotomy around the knee in children.when and why?
Osteotomy around the knee in children.when and why?Osteotomy around the knee in children.when and why?
Osteotomy around the knee in children.when and why?
ROBERT ELBAUM
 
Les tendinopathies chez l'enfant
Les tendinopathies chez l'enfant   Les tendinopathies chez l'enfant
Les tendinopathies chez l'enfant
ROBERT ELBAUM
 
Chirurgie orthopédique pédiatrique
Chirurgie orthopédique pédiatrique  Chirurgie orthopédique pédiatrique
Chirurgie orthopédique pédiatrique
ROBERT ELBAUM
 
Quel sport pour quelle enfant?
Quel sport pour quelle enfant?Quel sport pour quelle enfant?
Quel sport pour quelle enfant?
ROBERT ELBAUM
 
Pathologie orthopedique de l'enfant
Pathologie orthopedique de l'enfantPathologie orthopedique de l'enfant
Pathologie orthopedique de l'enfant
ROBERT ELBAUM
 
Pathologie ortho de l'enfant module 1
Pathologie ortho de l'enfant module 1Pathologie ortho de l'enfant module 1
Pathologie ortho de l'enfant module 1
ROBERT ELBAUM
 

More from ROBERT ELBAUM (20)

Troubles statiques et rotationnels des membres inferieurs
Troubles statiques et rotationnels des membres inferieursTroubles statiques et rotationnels des membres inferieurs
Troubles statiques et rotationnels des membres inferieurs
 
Posttraumatic radio ulnar synostosis
Posttraumatic radio ulnar synostosis   Posttraumatic radio ulnar synostosis
Posttraumatic radio ulnar synostosis
 
French Functional Method for Congenital Clubfoot: 20 years of experience
French Functional Method for Congenital Clubfoot: 20 years of experienceFrench Functional Method for Congenital Clubfoot: 20 years of experience
French Functional Method for Congenital Clubfoot: 20 years of experience
 
Les boiteries chez l'enfant
Les boiteries chez l'enfantLes boiteries chez l'enfant
Les boiteries chez l'enfant
 
La luxation congenitale de la hanche
La luxation congenitale de la hancheLa luxation congenitale de la hanche
La luxation congenitale de la hanche
 
Orthopaedic support with 3D printing in children
Orthopaedic support with 3D printing in childrenOrthopaedic support with 3D printing in children
Orthopaedic support with 3D printing in children
 
Digitized manual palpation: a new method of evaluating posture and its defor...
 Digitized manual palpation: a new method of evaluating posture and its defor... Digitized manual palpation: a new method of evaluating posture and its defor...
Digitized manual palpation: a new method of evaluating posture and its defor...
 
Knee osteochondritis and platelet rich plasma
Knee osteochondritis and platelet  rich plasmaKnee osteochondritis and platelet  rich plasma
Knee osteochondritis and platelet rich plasma
 
Aspect particulier en traumatologie pédiatrique
Aspect particulier en traumatologie pédiatriqueAspect particulier en traumatologie pédiatrique
Aspect particulier en traumatologie pédiatrique
 
Fractures in Children: Is conservative treatment still alive?
Fractures in Children: Is conservative treatment still alive?Fractures in Children: Is conservative treatment still alive?
Fractures in Children: Is conservative treatment still alive?
 
L'embrochage centromédullaire élastique stable (ECMES) chez l'enfant
L'embrochage centromédullaire élastique stable (ECMES) chez l'enfantL'embrochage centromédullaire élastique stable (ECMES) chez l'enfant
L'embrochage centromédullaire élastique stable (ECMES) chez l'enfant
 
Le torticoli congenital: Musculaire ou Postural?
Le torticoli congenital: Musculaire ou Postural?Le torticoli congenital: Musculaire ou Postural?
Le torticoli congenital: Musculaire ou Postural?
 
Spondylolyse chez l'enfant
Spondylolyse chez l'enfant Spondylolyse chez l'enfant
Spondylolyse chez l'enfant
 
Congenital Hallux varus: How to deal with it?
Congenital Hallux varus: How to deal with it?Congenital Hallux varus: How to deal with it?
Congenital Hallux varus: How to deal with it?
 
Osteotomy around the knee in children.when and why?
Osteotomy around the knee in children.when and why?Osteotomy around the knee in children.when and why?
Osteotomy around the knee in children.when and why?
 
Les tendinopathies chez l'enfant
Les tendinopathies chez l'enfant   Les tendinopathies chez l'enfant
Les tendinopathies chez l'enfant
 
Chirurgie orthopédique pédiatrique
Chirurgie orthopédique pédiatrique  Chirurgie orthopédique pédiatrique
Chirurgie orthopédique pédiatrique
 
Quel sport pour quelle enfant?
Quel sport pour quelle enfant?Quel sport pour quelle enfant?
Quel sport pour quelle enfant?
 
Pathologie orthopedique de l'enfant
Pathologie orthopedique de l'enfantPathologie orthopedique de l'enfant
Pathologie orthopedique de l'enfant
 
Pathologie ortho de l'enfant module 1
Pathologie ortho de l'enfant module 1Pathologie ortho de l'enfant module 1
Pathologie ortho de l'enfant module 1
 

Recently uploaded

POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptx
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxPOTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptx
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptx
souravpaul769171
 
Medical oncologic management of Colorectal cancer-1-1.pptx
Medical oncologic management of Colorectal cancer-1-1.pptxMedical oncologic management of Colorectal cancer-1-1.pptx
Medical oncologic management of Colorectal cancer-1-1.pptx
robel26
 
Recognizing and Managing Bacterial Vaginosis.pptx
Recognizing and Managing Bacterial Vaginosis.pptxRecognizing and Managing Bacterial Vaginosis.pptx
Recognizing and Managing Bacterial Vaginosis.pptx
FFragrant
 
Nosodes in Homeopathy, Understanding the Basis and Applications.pptx
Nosodes in Homeopathy, Understanding the Basis and Applications.pptxNosodes in Homeopathy, Understanding the Basis and Applications.pptx
Nosodes in Homeopathy, Understanding the Basis and Applications.pptx
jeearu
 
AGARICUS MUSCARIUS.pptx Keynotes by H.C. Allen
AGARICUS MUSCARIUS.pptx  Keynotes by H.C. AllenAGARICUS MUSCARIUS.pptx  Keynotes by H.C. Allen
AGARICUS MUSCARIUS.pptx Keynotes by H.C. Allen
DR.P.S SUDHAKAR
 
JULY 2024 Oncology Cartoons by Dr Kanhu Charan Patro
JULY 2024 Oncology Cartoons by Dr Kanhu Charan PatroJULY 2024 Oncology Cartoons by Dr Kanhu Charan Patro
JULY 2024 Oncology Cartoons by Dr Kanhu Charan Patro
Kanhu Charan
 
KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...
KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...
KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...
DrMalathiVenketesham
 
2nd week of Human development .embryology
2nd week of Human development .embryology2nd week of Human development .embryology
2nd week of Human development .embryology
Mithilesh Chaurasia
 
Comfort, Rest, Sleep and Pain.pptx
Comfort, Rest, Sleep  and Pain.pptxComfort, Rest, Sleep  and Pain.pptx
Comfort, Rest, Sleep and Pain.pptx
Nandish Sannaiah
 
Mainstreaming #CleanLanguage in healthcare.pptx
Mainstreaming #CleanLanguage in healthcare.pptxMainstreaming #CleanLanguage in healthcare.pptx
Mainstreaming #CleanLanguage in healthcare.pptx
Judy Rees
 
SA Gastro Cure(pancreatic cancer treatment in india).pptx
SA Gastro Cure(pancreatic cancer treatment in india).pptxSA Gastro Cure(pancreatic cancer treatment in india).pptx
SA Gastro Cure(pancreatic cancer treatment in india).pptx
VinothKumar70905
 
lessonplan JTR.pptx For medical education
lessonplan JTR.pptx For medical educationlessonplan JTR.pptx For medical education
lessonplan JTR.pptx For medical education
DrJALAGAMTHIRUPATHIR
 
Drug Repurposing for Parasitic Diseases.pptx
Drug Repurposing for Parasitic Diseases.pptxDrug Repurposing for Parasitic Diseases.pptx
Drug Repurposing for Parasitic Diseases.pptx
drebrahiim
 
Respiratory system at glance- Neonatology
Respiratory system at glance- NeonatologyRespiratory system at glance- Neonatology
Respiratory system at glance- Neonatology
Dr. Habibur Rahim
 
Geriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptx
Geriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptxGeriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptx
Geriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptx
Dinesh Danny
 
FUNCTIONAL DYSPEPSIA by Dr. Maryam Iqbal
FUNCTIONAL DYSPEPSIA by Dr. Maryam IqbalFUNCTIONAL DYSPEPSIA by Dr. Maryam Iqbal
FUNCTIONAL DYSPEPSIA by Dr. Maryam Iqbal
Zain Umar
 
Top 10 Habits for Longevity [Biohacker Summit 2024]
Top 10 Habits for Longevity [Biohacker Summit 2024]Top 10 Habits for Longevity [Biohacker Summit 2024]
Top 10 Habits for Longevity [Biohacker Summit 2024]
Olli Sovijärvi
 
Introduction to Radiotherapy technology I.pptx
Introduction to Radiotherapy technology I.pptxIntroduction to Radiotherapy technology I.pptx
Introduction to Radiotherapy technology I.pptx
JalalEltabib1
 
Abnormal CSF Diagnosis and Lumbar puncture
Abnormal CSF Diagnosis and Lumbar punctureAbnormal CSF Diagnosis and Lumbar puncture
Abnormal CSF Diagnosis and Lumbar puncture
Preet Mehta
 
selllllllllllllllllllllllllllllllllllllllllllllll.pptx
selllllllllllllllllllllllllllllllllllllllllllllll.pptxselllllllllllllllllllllllllllllllllllllllllllllll.pptx
selllllllllllllllllllllllllllllllllllllllllllllll.pptx
Joebest8
 

Recently uploaded (20)

POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptx
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxPOTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptx
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptx
 
Medical oncologic management of Colorectal cancer-1-1.pptx
Medical oncologic management of Colorectal cancer-1-1.pptxMedical oncologic management of Colorectal cancer-1-1.pptx
Medical oncologic management of Colorectal cancer-1-1.pptx
 
Recognizing and Managing Bacterial Vaginosis.pptx
Recognizing and Managing Bacterial Vaginosis.pptxRecognizing and Managing Bacterial Vaginosis.pptx
Recognizing and Managing Bacterial Vaginosis.pptx
 
Nosodes in Homeopathy, Understanding the Basis and Applications.pptx
Nosodes in Homeopathy, Understanding the Basis and Applications.pptxNosodes in Homeopathy, Understanding the Basis and Applications.pptx
Nosodes in Homeopathy, Understanding the Basis and Applications.pptx
 
AGARICUS MUSCARIUS.pptx Keynotes by H.C. Allen
AGARICUS MUSCARIUS.pptx  Keynotes by H.C. AllenAGARICUS MUSCARIUS.pptx  Keynotes by H.C. Allen
AGARICUS MUSCARIUS.pptx Keynotes by H.C. Allen
 
JULY 2024 Oncology Cartoons by Dr Kanhu Charan Patro
JULY 2024 Oncology Cartoons by Dr Kanhu Charan PatroJULY 2024 Oncology Cartoons by Dr Kanhu Charan Patro
JULY 2024 Oncology Cartoons by Dr Kanhu Charan Patro
 
KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...
KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...
KUSTHA PPT .pdf KUSTHA definition, classification, and modern probable correl...
 
2nd week of Human development .embryology
2nd week of Human development .embryology2nd week of Human development .embryology
2nd week of Human development .embryology
 
Comfort, Rest, Sleep and Pain.pptx
Comfort, Rest, Sleep  and Pain.pptxComfort, Rest, Sleep  and Pain.pptx
Comfort, Rest, Sleep and Pain.pptx
 
Mainstreaming #CleanLanguage in healthcare.pptx
Mainstreaming #CleanLanguage in healthcare.pptxMainstreaming #CleanLanguage in healthcare.pptx
Mainstreaming #CleanLanguage in healthcare.pptx
 
SA Gastro Cure(pancreatic cancer treatment in india).pptx
SA Gastro Cure(pancreatic cancer treatment in india).pptxSA Gastro Cure(pancreatic cancer treatment in india).pptx
SA Gastro Cure(pancreatic cancer treatment in india).pptx
 
lessonplan JTR.pptx For medical education
lessonplan JTR.pptx For medical educationlessonplan JTR.pptx For medical education
lessonplan JTR.pptx For medical education
 
Drug Repurposing for Parasitic Diseases.pptx
Drug Repurposing for Parasitic Diseases.pptxDrug Repurposing for Parasitic Diseases.pptx
Drug Repurposing for Parasitic Diseases.pptx
 
Respiratory system at glance- Neonatology
Respiratory system at glance- NeonatologyRespiratory system at glance- Neonatology
Respiratory system at glance- Neonatology
 
Geriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptx
Geriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptxGeriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptx
Geriatric radiography.pptx Geriatric radiography.pptxGeriatric radiography.pptx
 
FUNCTIONAL DYSPEPSIA by Dr. Maryam Iqbal
FUNCTIONAL DYSPEPSIA by Dr. Maryam IqbalFUNCTIONAL DYSPEPSIA by Dr. Maryam Iqbal
FUNCTIONAL DYSPEPSIA by Dr. Maryam Iqbal
 
Top 10 Habits for Longevity [Biohacker Summit 2024]
Top 10 Habits for Longevity [Biohacker Summit 2024]Top 10 Habits for Longevity [Biohacker Summit 2024]
Top 10 Habits for Longevity [Biohacker Summit 2024]
 
Introduction to Radiotherapy technology I.pptx
Introduction to Radiotherapy technology I.pptxIntroduction to Radiotherapy technology I.pptx
Introduction to Radiotherapy technology I.pptx
 
Abnormal CSF Diagnosis and Lumbar puncture
Abnormal CSF Diagnosis and Lumbar punctureAbnormal CSF Diagnosis and Lumbar puncture
Abnormal CSF Diagnosis and Lumbar puncture
 
selllllllllllllllllllllllllllllllllllllllllllllll.pptx
selllllllllllllllllllllllllllllllllllllllllllllll.pptxselllllllllllllllllllllllllllllllllllllllllllllll.pptx
selllllllllllllllllllllllllllllllllllllllllllllll.pptx
 

Avulsion simultanée bilatérale tubérosité tibiale antérieure

  • 1. Robert ELBAUM Clinique Edith Cavell, Brussels, Erasme Universitary Hospital Belgium
  • 2.  Avulsion-fracture of the anterior tibial tubercle (ATT) occurs in adolescents, predominantly male.  Avulsion fracture of the ATT represents 3% of all injuries of the proximal tibia and 0.4 to 2.4% of all epiphyseal fractures .  From 1853 till now, more than 250 cases have been reported in the literature.
  • 3.  Simultaneous bilateral avulsion fractures of the tibial tubercle are very uncommon.  Since the first description by Borsch-Madsen in 1955 , 15 cases have been reported. Associated patellar ligament avulsion is also uncommon .  We report another bilateral case featuring these two rare injuries.  We will also discuss the appropriate classification, the aetiopathogenenesis of this injury and the proposed treatment.
  • 4.  a 16-year old boy  Following a jump on both feet.  2 swollen knees and a marked tenderness over the tibial tubercles.  Active extension was impossible bilaterally.  X-Ray :bilateral avulsion fracture of the tibial tubercle, type 3A according to Ogden’s classification.
  • 5.  L knee: complete avulsion of the tibial tuberosity with an intact patellar ligament. R knee: partial disruption of the patellar ligament  the fragments were reduced and fixed with two cannulated screws. The right patellar ligament was repaired.
  • 6.  Six months later the cannulated screws were removed in one day surgery.  1Y FU: no pain, no functional limitation and had resumed his sporting activity (judo).  X-Ray :complete remodeling of the tibial tubercle.
  • 7. WATSON-JONES (1976) OGDEN (1980) type I: avulsion fracture of the distal part of the tibial tubercle; type II: displacement of the lip of the anterior part of the tibial epiphysis. type III :fracture of the base of the lip with propagation into the knee joint. 3 subgroups A or B, with a possible intra-articular extension of the fracture as well as comminution of the fragment
  • 8.  In 1990, Frankl described two cases of ATT avulsion-fracture associated with avulsion of the patellar ligament. He proposed an addition to the classification to include avulsion of the patellar ligament (Type I-C).  Ryu and Debenham subsequently added a fourth type corresponding to an extension of the fracture to the posterior cortex through the growth plate (Salter Harris type 2).
  • 9.  The tibial tubercle physis is in continuity with that of the tibial plateau. The physis progressively fuses from posterior to anterior, making it most vulnerable to avulsion in adolescents aged 13-16 years.
  • 10.  During take-off or a jump, the quadriceps mechanism forcefully contracts against the patellar tendon insertion. When the force exceeds the strength of the tibial tubercle physis, a fracture is generated, leading to avulsion of the tibial tubercle.
  • 11.  Indirect force caused by sudden contraction of the quadriceps muscle.  Acute passive flexion of the knee against a contracting quadriceps, such as landing after a jump (as in our case) is another mechanism of injury
  • 12.  Osgood Schlatter  patella infera  tight hamstrings  disorders involving physeal abnormalities.  …
  • 14. AUTHORS YEAR SEX AGE N Classification Circonstance Mechanism simultaneity TR last FU BORCH-MADSEN 1954 M 17 1 W-J TYPEIII ORIF OGDEN and coll 1980 M 14 1 W-J TYPEIII ORIF HENRARD et coll 1983 M 1 ORIF MAAR et coll 1988 M 16A 1 W-J TYPE III Basketball jump YES ORIF 3Y LEPSE et coll 1988 M 14A 1 W-J TYPE III Gymnast forward flip YES ORIF 1Y INOUE et coll 1991 M 16Y 1 W-J Type IV SIEBERT et coll 1995 M 16A 1 OGDEN 1B L +SALTER 2 R Athletism Starting YES ORIF 20W MIRLY and coll 1996 M MOSIER et coll 2000 M 15Y 1 OGDEN IIIB+ IV YES ERGUN et coll 2003 M 16Y 1 OGDEN 2B Bilat Basketball landing after forcefull jump YES ORIF 27M HAMILTON et coll 2006 M 13Y 1 TYPE I R+TYPE II L Soccer jump YES ORIF SLOBOGEAN et coll 2006 M 16Y 1 TYPE IV L+TYPE III R Running sudden stop YES L:Closed reduction R:ORIF 1Y 6M GEORGIOU et coll 2007 M 17Y 1 W-J TYPE III Sport jump YES ORIF NEUGBAUER et coll 2007 M 16Y 1 OGDEN 3A bilat Gymnast jump YES ORIF ARREDONDO-GOMEZ et coll 2007 M 14Y 1 OGDEN3 A R +OGDEN 3B G Soccer Indirect YES ORIF SCHAFFER et coll 2008 M 13Y 1 SALTER 2 R+ SALTER 3 L Long Jump take off and landing YES ORIF
  • 15.  Male,13 - 17 y ,close to skeletal maturity.  Causal mechanism :sudden jump with a landing on the ground while contracting the quadriceps muscle.  According to the Watson-Jones and Ogden classifications, most cases were type IIIA or B.  The type III fractures involving a growth plate and extending through the articular surface, appear to do well following open reduction and internal fixation despite their bilateral nature.  No report of growth disturbance of the proximal tibial epiphysis after that type of injury.
  • 16.  Recommandation for type III fracture: CT scan to evaluate the intraarticular surface.  Accurate diagnosis of the lesion is important to determine the appropriate treatment in order to avoid malfunction of the extensor mechanism of the knee in case of avulsion of the patellar ligament (type 1-C).  Open reduction with internal fixation (screw, wiring or K-wire) has been the common treatment for this type of lesion.
  • 17.  Bilateral simultaneous avulsion fracture of the anterior tibial tubercle (ATT) are extremely rare.  We believe that treatment should always include open reduction and internal fixation for all type II or III lesions.  It appears from the literature that the recovery and functional outcome of bilateral injuries is comparable to those of unilateral tibial tubercle avulsion fractures: results have been good to excellent in most of the cases.