Fatal pulmonary thromboembolism in an adolescent with tibial tuberosity avulsion fracture: case report

Abstract

Tibial tuberosity avulsion fracture is an uncommon injury in adolescents, primarily associated with high-impact sports activities and the immaturity of the knee extensor mechanism. Although the most frequent complications are local, such as compartment syndrome or tendon ruptures, pulmonary thromboembolism in this context is exceptionally rare. The objective of this study was to present the case of an adolescent who developed a massive pulmonary embolism following a non-displaced tibial tuberosity fracture and to explore potential risk factors. A retrospective descriptive analysis was conducted of the clinical case of a 14-year-old male patient, with no relevant medical history, who sustained a type IIIa tibial tuberosity fracture while playing football. After 72 hours of hospitalization awaiting surgical resolution, he developed an acute clinical picture with dyspnea, hematemesis, loss of consciousness, and cardiorespiratory arrest, and died despite advanced resuscitation efforts. Autopsy confirmed massive pulmonary embolism as the cause of death, with no evidence of deep vein thrombosis. These findings raise clinical questions about the need to assess thromboembolic risk in adolescents with long bone fractures, even in the absence of recognized predisposing factors. This case suggests that thromboembolic prophylaxis might be considered in specific scenarios not currently addressed by existing guidelines and highlights the urgent need to develop pediatric trauma-specific risk stratification tools to prevent fatal outcomes.