Tibial tuberosity avulsion

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Tibial tuberosity avulsion fracture in a Jack Russell Terrier[1]

Tibial tuberosity avulsion is a distraction fracture of the tibial tuberosity, often caused by sudden shear forces, tensile trauma or following a fall from height.

It resembles Osgood-Schlatter disease in humans[2].

Immature large-breed dogs appear more predisposed[3], and this condition is also seen following tibial tuberosity transposition with repair of cruciate ligament injury[4].

Clinically-affected dogs often present with acute lameness to the affected leg.

Radiographs usually show varying degrees of distraction of the tibial tuberosity away from the proximal tibia. In some cases, epiphyseal separation may extended to produce Salter-Harris type II fracture of the caudal tibial metaphysis[5].

In immature dogs with only partial avulsion, the main radiographic features are widening of the tibial-tuberosity-physis with reactive new bone and loss of edge definition of the epiphyseal and metaphyseal margins.

Care must be taken to determine stifle stability and exclude the possibility of concurrent cruciate ligament injury.

treatment with immature dogs is usually conservative with restricted exercise, anti-inflammatory medication and regular radiographs on a monthly basis.

In adult dogs with severe avulsion, treatment is usually successful with repositioning of the distracted fragment and pinning with Kirschner wires and a tension band to secure the fracture to the original location[6] or use of a transarticular external skeletal fixation.

References

  1. PetPlace
  2. von Pfeil DJ et al (2009) Does Osgood-Schlatter disease exist in the dog? Vet Comp Orthop Traumatol 22(4):257-263
  3. von Pfeil DJ et al (2012) Minimally displaced tibial tuberosity avulsion fracture in nine skeletally immature large breed dogs. Vet Comp Orthop Traumatol 25(6):524-531
  4. Higgins B et al (2010) The use of transarticular external skeletal fixation in the management of failed tibial tuberosity transposition in five dogs. Vet Comp Orthop Traumatol 23(2):109-113
  5. Gower JA et al(2008) Tibial tuberosity avulsion fracture in dogs: a review of 59 dogs. J Small Anim Pract 49(7):340-343
  6. Pratt JN (2001) Avulsion of the tibial tuberosity with separation of the proximal tibial physis in seven dogs. Vet Rec 149(12):352-356