ORIF Tibial Tubercle Fracture

Indications

Figure 24-1

Lateral X-ray demonstrating displaced tibial tubercle fracture.

Patient Positioning (Figure 24-2)

Supine on the radiolucent table
Bump underneath ipsilateral buttocks to prevent patient external rotation

Figure 24-2 Positioning of leg with elevation to allow for lateral fluoroscopic views.
Tourniquet
Set up for fluoroscopic AP and lateral views of the knee in order to confirm reduction and screw placement
radiolucent triangle

Surgical Approaches

Esmarch of the limb with elevation of the tourniquet
Direct anterior skin incision from the midpoint of patellar tendon proximally to 3 cm below the caudal end of tibia tubercle.
Significant soft tissue and periosteal stripping with a large hematoma will be encountered (Figure 24-3).

Reduction and Fixation Techniques

Reduction in these fractures is easily performed and can be aided by the following tricks:

Complete irrigation of the hematoma and cleaning of the fracture edges of any potential periosteum/soft tissue, which would block fracture edges coming together
Reduction done in extension with towel clamp pulling fracture distally

Adequacy of reduction is assessed by direct visualization of the cortical edges coming together (Figure 24-4)