Differential Diagnosis

  • Tibial eminence (spine) fracture
  • Collateral ligament injury
  • Tibial tubercle avulsion
  • Meniscal tear
  • Patellar sleeve fracture
  • Tibial plateau fracture
13 year old boy's x-ray image presenting with knee pain after a fall resolution

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).

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