Title : Bilateral tibial tuberosity avulsion fractures in an adolescent rugby player
Abstract:
Introduction: Tibial tuberosity avulsion fractures are uncommon injuries, accounting for less than 1% of all paediatric fractures. Bilateral occurrences are exceedingly rare, with limited cases documented in the literature. We present the case of a 15-year-old male rugby player who sustained simultaneous bilateral tibial tuberosity fractures following a tackle during play.
Method: The patient, otherwise healthy with Osgood–Schlatter disease, presented after being tackled in a rugby match. Physical examination revealed bilateral knee effusions, tenderness over the tibial tuberosities, and loss of extensor mechanism. Radiographs confirmed bilateral tibial tuberosity fractures. In A&E, both knees were reduced to an acceptable position due to skin compromise. The injuries were classified as Ogden type IIIB.
Surgery was performed the next day using midline incisions over each tibial tuberosity. Intra-operative findings included soft tissue stripping, retinacular disruption, distal periosteal avulsion, and haematoma formation bilaterally. The anterior horns of the medial menisci were visualised, intact and stable, with no significant chondral steps post-fixation. ORIF were achieved using 4.5 mm lag screws and 4 mm cannulated screws under image intensifier guidance. Stable fixation and satisfactory reduction were confirmed intra-operatively.
Results: Post-operatively, the patient was immobilised in bilateral knee splints in full extension for four weeks. Follow-up reviews showed healed wounds with no infection. X-rays showed acceptable alignment and no loss of fixation. At four weeks, knee braces were adjusted to allow gradual range of motion: 0–30 degrees on the right and 0–20 degrees on the left due to ongoing lateral knee discomfort. A structured physiotherapy programme was initiated, increasing flexion in subsequent weeks.
Conclusion: This case illustrates the rare occurrence of simultaneous bilateral tibial tuberosity avulsion fractures in an adolescent, managed successfully with single-setting bilateral fixation. It also highlights the need for coordinated post-operative care and structured rehabilitation pathway to optimise recovery in complex bilateral injuries.
