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Musculoskeletal and Sports Medicine

Euro Step Gone Wrong: Bilateral Salter-Harris Fractures in a 14 Year Old after a Layup

Euro Step Gone Wrong: Bilateral Salter-harris Fractures in a 14 Year Old After a Layup

Thursday, November 16, 2023

    Primary Author(s)

  • Aniroodh T. Reddy, MD

    Resident Physician
    Nassau University Medical Center PM&R Program
    east meadow, New York

    • Co-Author(s)

  • Corey Spector, DO

    Resident Physician
    Nassau University Medical Center PM&R Program
    East Meadow, New York

  • Diane N. Moya, DO

    Resident Physician
    Nassau University Medical Center PM&R Program
    East Meadow, New York

  • Jack Leal, DO

    Physical Medicine and Rehabilitation Resident
    Nassau University Medical Center PM&R Program
    New Hyde Park, New York

  • Kanwardeep Singh, MD

    Resident Physician
    Nassau University Medical Center PM&R Program
    East Meadow, New York

  • TP

    Thomas Pobre, MD

    Attending Physician
    Nassau University Medical Center PM&R Program
    East Meadow, New York

Case Diagnosis: A 14-year-old male presents with bilateral Salter-Harris fractures after a routine layup.

Case Description or Program Description: A 14-year-old male presented to the hospital for evaluation of bilateral knee pain and swelling after attempting a layup at a basketball practice. The patient said that he felt an immediate pop with pain in the bilateral knees when jumping. The patient was found to have a right Salter-Harris tibial fracture type 2, a right patellar tendon rupture, and a left tibial tubercle fracture with an intact neurovascular exam. An MRI confirmed a right-sided Salter-Harris type 2 fracture of the proximal tibia. The patient had a mildly uplifted tubercle with an intact patellar tendon likely related to partial avulsion. The patient also had a high-grade partial/complete tear of the medial patellofemoral ligament. CT of the left leg showed a left-sided salter harris type 3 configuration with moderate hemarthrosis. The patient was taken for bilateral open reduction and internal fixation of the tibial tubercles bilaterally. The patient was then placed in knee splints and then transitioned to Bledsoe braces bilaterally locked in extension.

Setting: Tertiary Care Center

Assessment/Results: At the five-week postoperative follow-up, the patient was able to return to physical therapy at school and was maintained in Bledsoe braces.

Discussion (relevance): Proximal tibial physis fractures are uncommon, and most often related to sports activities. Between 10-12 years of age, the most frequent mechanism of injury is a hyperextension trauma of the knee during jumping, as was seen in our patient. To the best of our knowledge, only three known cases of simultaneous bilateral physeal injury have been reported.

Conclusions: This case report shows an extremely rare presentation of bilateral Salter-Harris fractures in the context of athletic activity.