Risk of tibial fracture after patella distallization and strategies for prevention

OBJECTIVES: To identify the risk of spontaneous proximal tibial shaft fracture after distallization of the patella, and prevention strategies. METHODS: CASE REPORTS AND OPERATIVE TECHNIQUE. Two cases of tibial fracture are presented, arising from a stress riser in the tibial crest due to a residual anterior cortical defect. There had been no warning symptoms before the fractures. RESULTS: The fractures required internal fixation of the proximal tibial shaft. DISCUSSION: Prevention requires check X-Ray prior to return to full activity after patella distallization, and possible further surgery if a residual cortical defect is identified. At the time of the index surgery, the risk of a residual cortical defect can be minimized by ensuring accurate apposition of the two anterior bone fragments, and applying compression across the site of an oblique osteotomy between those fragments where a bone segment is resected. CONCLUSION: Awareness of this potential complication should ensure effective preventative strategies.