A 13-Year-Old Boy with Knee Pain After a Fall

Differential Diagnosis

• Tibial eminence (spine) fracture
• Collateral ligament injury
• Tibial tubercle avulsion
• Meniscal tear
• Patellar sleeve fracture
• Tibial plateau fracture

Diagnosis

This patient experienced a tibial eminence (spine) fracture.

Learnings/What to Look for

• Tibial eminence (spine) fractures are unique to the growing skeleton and affect only three in 100,000 children who sustain injuries to the knee annually¹
• This fracture is a variant and similar to an ACL injury, also caused by hyperextension of the knee with rotation of the femur on the tibia
• X-rays should be sufficient to visualize fractures through the tibial eminence
• MRI or CT may be useful in further categorizing injury. In addition, MRI can help in identifying pieces of chondral fracture of the tibial spines

Pearls for Urgent Care Management

• Large effusions with significant pain or limitation of flexion benefit from arthrocentesis of hemarthrosis for symptomatic relief
• Initial treatment should include knee immobilization with fiberglass splinting in full extension and non-weight bearing with crutches
• Follow-up with orthopedics is recommended in 2-3 days for casting and to assess if surgical therapy is necessary. Significantly displaced avulsions require closed or open reduction with internal fixation
• Emergency department referral is necessary for any concerns about neurovascular status or for pain out-of-proportion

Reference

1. Shin YW, Uppstrom TJ, Haskel JD, Green DW. The tibial eminence fracture in skeletally immature patients. Curr Opin Pediatr. 2015;27(1):50-57.

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).