Stress avulsion of the tibial tuberosity after tension band wiring of a patellar fracture: a case report

Extensor mechanism reconstruction and joint preservation surgery following a tibial tuberosity fracture in giant cell tumor of bone: A case report

INTRODUCTION AND IMPORTANCE

Pathologic fractures of the tibial tuberosity secondary to giant cell tumor of bone are rare injuries. While there are several well-described methods in the literature to reattach the tibial tuberosity, these techniques rely on good quality bone. However, in the presence of diseased and weak bone, additional factors have to be considered.

CASE PRESENTATION

A 47-year-old man with a Giant Cell Tumor of bone affecting the proximal tibia presented with a displaced avulsion fracture of the tibial tuberosity. The patient underwent surgical curettage, bone grafting and osteosynthesis with reattachment of the tibial tuberosity. Eighteen months after surgery there is no evidence of tumor recurrence, and despite mild knee pain and a limited range of movement, the patient has returned to work.

CLINICAL DISCUSSION

The extensor mechanism was repaired by first reinforcing the tuberosity fragment with an autograft before reattaching it using a tension band FibreWire ® suture. Without access to a tumor endoprosthesis we used a joint sparing approach to treat the Giant Cell Tumor.

CONCLUSION

Patients with dual-pathology present technical challenges in repairing the extensor mechanism and treating the underlying condition. Surgeons must address competing priorities in a holistic, patient-centred approach consistent with their working environment.

Split Fracture: A Complication of Cerclage Wiring of Acute Patellar Fracture

Introduction:

Iatrogenic patellar fracture is reported as a complication of patella procedures, such as medial patellofemoral ligament reconstruction, reconstruction of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and resurfacing the patella in total knee arthroplasty.

Case Presentation:

A 65-year-old lady with right patella fracture was treated with open reduction and cerclage wiring. An iatrogenic split fracture was noted during tension of the cerclage wire and was successfully managed by screw fixation of the split fracture.

Conclusions:

Split fracture is a rare complication of circumferential cerclage wiring of patellar fracture. The surgeon should be aware of the contributing factors in order to avoid this complication.