(Kiosk 2) Growth Plate or Fracture?

Case Diagnosis: Tibial Tubercle Avulsion Fracture

Case Description or Program Description: A 14-year-old boy presented with left leg pain after sustaining an injury while playing basketball with his friends when he was accidentally kicked in the shin, resulting in landing on his left leg. He experienced immediate discomfort and was unable to bear weight. The patient sought care at an urgent care where x-rays of his left tibia and fibula did not reveal any acute fractures. The patient was discharged home with a pair of crutches. Upon presentation to our clinic, he complained of pain and swelling over the proximal and middle thirds of the tibia. He was maximally tender to palpation over the tibial plateau. Repeat images revealed widening of the proximal tibial physis from anterior to the midportion underneath the tibial tuberosity, concerning for proximal tibial growth plate diastases/fracture with posterior tilt of the tibial plateau. X-rays of his left knee and contralateral leg were obtained, which confirmed tibial tubercle avulsion fracture.

Setting: Outpatient

Assessment/Results: This patient underwent open reduction and internal fixation of the left tibial tubercle fracture. He was then placed in a long-leg cylinder cast and discharged home the following day.

Discussion (relevance): Tibial tubercle avulsion fractures are rather uncommon fracture patterns, accounting for less than 1% of epiphyseal injuries and around 3% of all proximal tibial fractures, more commonly seen in male adolescents. A tibial tubercle avulsion fracture can be associated with a wide range of additional injuries, including compartment syndrome. This case highlights the importance of a thorough workup for accurate diagnosis, leading to better management and outcome.

Conclusions: Although it is relatively rare, a tibial tubercle avulsion fracture should be included in a differential diagnosis in adolescents, complaining of proximal tibial pain. As the epiphysis is still open in this age group, comparison with the contralateral side may be beneficial for accurate diagnosis.