A 10-Year-Old Male with Knee Pain After a Football Game

Differential Diagnosis

• ACL/PCL tear
• Capsular disruption
• Dislocation
• Displaced avulsion fracture of the tibial spine
• Meniscal tear

Diagnosis

The oval-shaped bone density projecting in the intercondylar notch region is a displaced avulsion fracture of the tibial spine, otherwise known as a tibial eminence fracture or ACL avulsion fracture.

Learnings/What to Look for

• ACL avulsion fractures are often associated with sports or other vigorous activity in children between the ages of 8 and 13 years
• The fracture occurs secondary to relative weakness of incompletely ossified tibial eminence compared to native ACL fibres

Pearls for Urgent Care Management and Considerations for Transfer

• Evaluate and document neurovascular status
• Assess for more serious considerations such as open fracture, compartment syndrome, or fracture/dislocation in the proximal or distal joint
• The knee should be immobilized in the urgent care center, with transfer to the ED or referral to an orthopedist as needed. Severe injury may require surgery

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