A 16 year old boy presented to the outpatient department in November 2009 with the history of painful swelling around the anterior aspect of both proximal tibia. On examination both the tibial tubercles were tender and prominent. Knee joints examination did not have any positive findings. He was diagnosed clinically to have bilateral OSD and treated conservatively with NSAIDS and compression bandage. Patient was symptomatically improved with the treatment.
He was brought to the outpatient department after 2 months in February 2010 with the history of jumping from the school compound wall (two feet height) while playing, followed by severe pain around anterior aspect of both knees and difficulty in walking. After few minutes the knees were swollen and he was unable to bear weight on both the legs and to flex and extend the knees. There was a palpable defect distal to the tibial tubercles with high riding patellae.
Radiographs of both knee joints AP and lateral views were taken which showed bilateral tibial tubercle avulsion fractures. (Fig. 1) According to Ogden classification right side was type IIa and leftside was IIb tibial tubercle avulsion fracture. Both sides were treated with open reduction and internal fixation with Tension Band Wiring (TBW) (Fig. 2 and 3).
Patient was positioned supine under tourniquet control. 7 cm medial parapatellar incision was taken to expose the fracture site. Fracture was reduced and confirmed clinically and radiologically under image intensifier and fixed with two 2 mm K wires and tension band wiring. The figure-of-eight wire was passed deep to the patellar ligament and through a transosseous tunnel 4cm distal to the fracture. Kirschner wires provided rotational stability, and were inserted through the proximal part of the tubercle and engaged the posterior cortex of the tibia under direct guidance of image intensification. Patient was put on cylindrical slab for 2 weeks and gradual mobilization of knee was started. Patient was allowed to bear weight with the help of walking frame.
Patient was followed up clinically and radiologically at 6 weeks, 12 weeks, and 6 months and 12 months and 22 months (Fig. 4). Implants were removed at the end of 12 months. At final follow up the knee range was 0 to 120  and completely pain free with patient doing all his activities without any functional limitations