Clinical and radiographic outcomes of Ogden type IV and V tibial tubercle fractures in adolescents

The aim of this research was to evaluate clinical and radiographic outcomes in patients with Ogden type IV and V tibial tubercle fractures treated at two tertiary hospitals. We conducted a retrospective review of patients with Ogden type IV and V tibial tubercle fractures treated between 2010 and 2024. Demographic data, fracture characteristics, mechanism of injury, treatment modality, and fixation method were recorded. Radiographic parameters were measured before and after treatment, and at final follow-up. Clinical outcomes included range of motion, return to sports and complications. Forty-one patients met the inclusion criteria; 95.1% were male, with a median age of 14 years and a mean follow-up of 3 years and 8 months. Sports-related trauma accounted for 80.4% of injuries. Forty fractures were Ogden type IV and one type V. Conservative treatment was used in four (9.7%) patients, whereas 37 (90.3%) patients underwent surgical fixation, mostly with 7.0-mm cannulated screws. Fracture union was achieved in all cases. Complications occurred in eight (19.5%) patients, including screw prominence, infection, varus deformity, limb-length discrepancy, and transient peroneal neuropraxia. No cases of compartment syndrome were observed. At final follow-up, 95.2% of patients returned to their preinjury level of sports participation, and 92.6% regained full knee range of motion. Radiographic evaluation demonstrated restoration and maintenance of tibial alignment. We conclude that Ogden type IV tibial tubercle fractures and the only one Ogden type V demonstrated favorable clinical, functional, and radiographic outcomes, with high union rates and a low incidence of severe complications.