A 14-year-old who took a fall two hours prior to presenting to the urgent care clinic

Resolution

The x-ray shows a subtle line running down through the epiphysis of the tibia into the joint, making this an intra-articular fracture.

In addition, note the dramatic widening of the tibial growth plate laterally.
The correct diagnosis is a Salter 3 displaced fracture. The physician performed a reduction, casted, and advised absolutely no weight bearing until further orthopaedic reassessment.

This case illustrates that if a patient who still has growth plates cannot ambulate, appli- cation of a posterior slab cast is indicated until reassessment by ortho. 
Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM.

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services