Tibial Crest Avulsion - Revision history

Fiorecastro at 17:44, 4 January 2023

2023-01-04T17:44:56Z

Bara at 12:44, 9 August 2012

2012-08-09T12:44:30Z

Bara at 17:11, 11 October 2011

2011-10-11T17:11:30Z

Bara at 17:11, 11 October 2011

2011-10-11T17:11:15Z

HelenD: Created page with "Also known as: '''''Tibial tubercle avulsion — Tibial tuberosity avulsion''''' ==Introduction== The tibial crest is the insertion point for the '''straight patellar tendon''' ..."

2011-08-31T09:19:58Z

Created page with "Also known as: '''''Tibial tubercle avulsion — Tibial tuberosity avulsion''''' ==Introduction== The tibial crest is the insertion point for the '''straight patellar tendon''' ..."

New page

Also known as: '''''Tibial tubercle avulsion — Tibial tuberosity avulsion'''''

==Introduction==
The tibial crest is the insertion point for the '''straight patellar tendon''' and it forms as a '''separate centre of ossification'''. Hyperflexion of the stifle joint can cause avulsion of the growth plate of the tibial crest in '''immature animals''', less than about 10 months of age.

It can occur in cats and dogs, and the Greyhound and Terrier breeds are overrepresented.

Avulsion fractures are uncommon in skeletally mature animals, although they can occur.

==Clinical Signs==
The animal will be unable to fix the stifle during weight-bearing, leading to '''lameness''' and decreased weight-bearing on the affected leg.

Other signs include '''pain and swelling on the cranial aspect of the joint'''.

The displaced tubercle can sometimes be '''palpated''' proximal to its normal position, and the patella will be positioned proximally in the trochlear groove.

The condition can be '''bilateral''', and in those cases the animal will have a crouched position and will be reluctant to move.

==Diagnosis==
'''Radiography''' provides a definitive diagnosis. Lateral and craniocaudal views are usually all that is necessary.

There is a normal radiolucent line between the tubercle and the tibit prior to fusion of the tubercle, and this should not be mistaken for a fracture.

The tibial tubercle will be displaced proximally if it is avulsed.

In unilateral cases it may be helpful to '''compare with radiographs of the contralateral side'''.

==Treatment==
'''Surgical repair''' is the treatment of choice as there is loss of function of the affected stifle joint.

In chronic cases, if healing is already evident radiographically, '''conservative management''' can be attempted, and the limb and stifle joint can be immobilised for 2-3 weeks in a cast or bandage, keeping the stifle in slight extension.

'''Surgery''' permits anatomic reduction of the avulsed fragment and return to function of the stifle joint.

The tibial crest is reattached using several different techniques:
:'''Kirchner wire fixation''': two Kirchner wires are driven through the tubercle and into the tibia, placed at divergent angles.
:'''Tension band wire fixation''': a tension band can be applied to the avulsed tubercle and counteracts the pull of the quadriceps muscle. Two small Kirchner wires are placed through the tubercle and into the tibia. Orthopaedic wire is then placed in a figure of eight fashion around the exposed ends of the Kirchner wires and through a hole drilled more distally into the tibia.

The tension band principle is the ideal method of treatment, however the compression at the fracture site can lead to '''early closure of the physis''' and subsequent limb deformities in growing animals.

In patients approaching skeletal maturity, at 8-10 months of age, the implants can be left in place.

In younger patients, implants should be '''removed after about 5 weeks''' to try and prevent early closure of the physis.

'''Post-operatively''', the limb should be immobilised in a padded bandage for 2 weeks and exercise should be restricted for a further 2 weeks.

'''Physiotherapy''' can be used to help promote joint motion.

==Prognosis==
The prognosis is '''good to excellent''' if the condition is treated early and anatomic and rigid fixation are achieved.

'''Complications''' include: implant failure such as pin bending or migration, wire breakage, and growth deformities.

{{Learning
|flashcards = [[Small Animal Emergency and Critical Care Medicine Q&A 19]]
}}

==References==
Denny, H. (2008) '''A guide to canine and feline orthopaedic surgery''' ''John Wiley and Sons''

Scott, H. (2007) '''Feline Orthopaedics''' ''Manson Publishing''

[[Category:To Do - Helen]]
[[Category:To Do - Review]]

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 Also known as: '''''Tibial tubercle avulsion — Tibial tuberosity avulsion'''''
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 {{review}}
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+==Webinars==
 [[Category:Musculoskeletal Diseases - Dog]]
 [[Category:Bones - Pathology]]
 [[Category:Expert Review - Small Animal]]

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 Also known as: '''''Tibial tubercle avulsion — Tibial tuberosity avulsion'''''
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 {{review}}
 [[Category:Musculoskeletal Diseases - Dog]]
 [[Category:Bones - Pathology]]
 [[Category:Expert Review - Small Animal]]

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 ==Introduction==
-The [[Hindlimb - Anatomy & Physiology#Tibiatibial crest]] is the insertion point for the '''straight patellar tendon''' and it forms as a '''separate centre of ossification'''. Hyperflexion of the stifle joint can cause avulsion of the growth plate of the tibial crest in '''immature animals''', less than about 10 months of age.
+The [[Hindlimb - Anatomy & Physiology#Tibia|tibial crest]] is the insertion point for the '''straight patellar tendon''' and it forms as a '''separate centre of ossification'''. Hyperflexion of the stifle joint can cause avulsion of the growth plate of the tibial crest in '''immature animals''', less than about 10 months of age.
 It can occur in cats and dogs, and the Greyhound and Terrier breeds are overrepresented.

@@ Line 2: / Line 2: @@
 ==Introduction==
-The tibial crest is the insertion point for the '''straight patellar tendon''' and it forms as a '''separate centre of ossification'''. Hyperflexion of the stifle joint can cause avulsion of the growth plate of the tibial crest in '''immature animals''', less than about 10 months of age.
+The [[Hindlimb - Anatomy & Physiology#Tibiatibial crest]] is the insertion point for the '''straight patellar tendon''' and it forms as a '''separate centre of ossification'''. Hyperflexion of the stifle joint can cause avulsion of the growth plate of the tibial crest in '''immature animals''', less than about 10 months of age.
 It can occur in cats and dogs, and the Greyhound and Terrier breeds are overrepresented.
@@ Line 20: / Line 20: @@
 '''Radiography''' provides a definitive diagnosis. Lateral and craniocaudal views are usually all that is necessary.
-There is a normal radiolucent line between the tubercle and the tibit prior to fusion of the tubercle, and this should not be mistaken for a fracture.
+There is a normal radiolucent line between the tubercle and the tibia prior to fusion of the tubercle, and this should not be mistaken for a fracture.
 The tibial tubercle will be displaced proximally if it is avulsed.
-In unilateral cases it may be helpful to '''compare with radiographs of the contralateral side'''.
+In unilateral cases, it may be helpful to '''compare with radiographs of the contralateral side'''.
 ==Treatment==
@@ Line 61: / Line 61: @@
 Scott, H. (2007) '''Feline Orthopaedics''' ''Manson Publishing''
-[[Category:To Do - Helen]]
-[[Category:To Do - Review]]
+{{review}}