Differential Diagnosis

  • Anterior cruciate ligament tear
  • Dislocation
  • Displaced avulsion fracture of the tibial spine
  • Meniscal tear
Twisted Knee in Backyard X-Ray - The Resolution
Figure 2 – The Resolution

Diagnosis

The image shows oval-shaped bone density projecting in the intercondylar notch region. This is a displaced avulsion fracture of the tibial spine, also known as a tibial eminence fracture or ACL avulsion fracture.

Learnings

  • ACL avulsion fractures are often associated with sports or other vigorous physical activity in children 8─13 years of age
  • The fracture occurs secondary to relative weakness of incompletely ossified tibial eminence compared to native ACL fibers

Pearls for Urgent Care Management

  • Evaluate and document neurovascular status
  • Evaluate for more serious considerations such as open fracture, compartment syndrome, or fracture/dislocation in the proximal or distal joint
  • Pain medication should be administered, with consideration to potential emergent surgical repair which would require NPO status
  • The knee should be immobilized prior to transfer

Acknowledgment: Images and case provided by Experity Teleradiology (www.experity/health.com/teleradiology).

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A 10-Year-Old Boy Who Twisted His Knee in the Backyard
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