Review Question - QID 167

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Tibial Eminence Fracture Etiology Pathophysiology QID: 167 (OBQ06.56)

QID 167 (Type "167" in App Search)

The AP radiograph in Figure A demonstrates an injury in a 13-year-old soccer player. What is the equivalent injury in a skeletally mature patient?

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Patella tendon rupture

30/1558

Posterior cruciate ligament tear

46/1558

Anterior cruciate ligament tear

92%

1435/1558

Lateral meniscus tear

12/1558

Posteromedial capsular avulsion

20/1558

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The radiograph demonstrates a displaced fracture of the tibial spine. The ACL inserts on the tibial eminence and the lateral aspect of the medial tibial spine. Mid-substance ACL tears are seen in both children and adults, but tibial spine fractures are seen primarily in the skeletally immature. The analogous injury in the adult knee would be an ACL tear, and if associated with a fracture, that would be a lateral capsule avulsion (Segond fracture). The Segond fracture results from excessive internal rotation and varus stress of the knee.

The Campos paper discusses that the iliotibial band and anterior oblique ligaments are thought to be involved in generation of the Segond fracture. Injuries associated with Segond fractures include ACL (75-100%) and meniscal (66-75%) tears.

Kocher et al found that narrower notch width index predisposes patients to ACL tear more than tibial spine fracture.