Variability in evaluation and treatment of tibial tubercle fractures among pediatric orthopedic surgeons

Michael W. Fields*, Neil K. Kaushal, Neeraj M. Patel, Sekinat K. McCormick, Craig P. Eberson, Michael L. Schmitz, Ishaan Swarup, John S. Blanco, Lindsay M. Crawford, O. Folorunsho Edobor-Osula

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The purpose of this study was to determine the variability in clinical management of tibial tubercle fractures among a group of pediatric orthopedic surgeons. Nine fellowship-trained academic pediatric orthopedic surgeons reviewed 51 anteroposterior and lateral knee radiographs with associated case age. Respondents were asked to describe each fracture using the Ogden classification (type 1–5 with A/B modifiers), desired radiographic workup, operative vs. nonoperative treatment strategy and plans for post-treatment follow-up. Fair agreement was reached when classifying the fracture type using the Ogden classification (k=0.39; P<0.001). Overall, surgeons had a moderate agreement on whether to treat the fractures operatively vs. nonoperatively (k=0.51; P<0.001). Nonoperative management was selected for 80.4% (45/56) of type 1A fractures. Respondents selected operative treatment for 75% (30/40) of type 1B, 58.3% (14/24) of type 2A, 97.4% (74/76) of type 2B, 90.7% (39/43) of type 3A, 96.3% (79/82) of type 3B, 71.9% (87/121) of type 4 and 94.1% (16/17) of type 5 fractures. Regarding operative treatment, fair/slight agreement was reached when selecting the specifics of operative treatment including surgical fixation technique (k=0.25; P<0.001), screw type (k=0.26; P<0.001), screw size (k=0.08; P<0.001), use of washers (k=0.21; P<0.001) and performing a prophylactic anterior compartment fasciotomy (k=0.20; P<0.001). Furthermore, surgeons had fair/moderate agreement regarding the specifics of nonoperative treatment including degree of knee extension during immobilization (k=0.46; P<0.001), length of immobilization (k=0.34; P<0.001), post-treatment weight bearing status (k=0.30; P<0.001) and post-treatment rehabilitation (k=0.34; P<0.001). Significant variability exists between surgeons when evaluating and treating pediatric tibial tubercle fractures.

Original languageEnglish (US)
Pages (from-to)E141-E146
JournalJournal of Pediatric Orthopaedics Part B
Issue number2
StatePublished - Mar 1 2022


  • Pediatric fractures of the tibia
  • Proximal tibia fractures
  • Tibial tubercle fractures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine


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