BACKGROUND: Acute avulsions of the tibial tubercle are extremely rare, with reported incidence being 0.4-2.7% of all physeal injuries. This particular injury is most common in males aged 12-17 who participate in increased athletic activities when the bones are still skeletally immature. While tubercle avulsion fractures are uncommon, the Ogden classification can guide which fractures require operative intervention. Advanced fractures are an important clinical entity as they may involve the entire proximal tibial physis with intra-articular extension. In addition, injury to the recurrent anterior tibial artery can lead to compartment syndrome in severe cases. The purpose of this video is to present a rare case of tibial tubercle avulsion fracture repaired with an open reduction and internal fixation technique.METHODS: A variety of operative techniques can be performed for tibial tubercle fractures based on the severity of the injury. This video presents the technique of open reduction and internal fixation of a patient with a Watson-Jones Type III tibial tubercle fracture. Relevant patient history, injury presentation and workup, nonoperative management, indications for surgery, pre and postoperative imaging, postoperative rehabilitation, and clinical outcomes are presented. The important features of the technique are highlighted and the rationale behind the approach is reviewed.RESULTS: In this video, we present a case of a patient with a tibial tubercle fracture and the technique for open reduction and internal fixation. Fracture fixation was achieved with two 4.5mm lag screws with the distal screw augmented with a single washer. Intraoperative fluoroscopy confirmed maintenance of the reduction and appropriate screw lengths. The patient performed well postoperatively. Clinical outcomes from the orthopaedic literature demonstrate excellent outcomes with favorable return to sport and rare complications.CONCLUSION: Surgical treatment of tibial tubercle avulsions provides anatomic reduction of displaced fractures. The extensor mechanism is repaired allowing a full range of motion and a gradual return to sports. The technique shown in this video provides excellent healing potential and may allow for earlier range of motion.