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paediatric

Pediatric Tibial Spine (ACL Eminence) Fracture

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 10-year-old boy presents after a twisting injury to his right knee during a soccer game. He felt a "pop" and immediate swelling developed. He is unable to weight bear due to pain. On examination, there is a large tense effusion. He has marked pain with passive extension. Lachman test is difficult to assess due to guarding but appears positive. There is no ligamentous laxity at 30 degrees flexion. Neurovascular examination is normal.
Lateral knee radiograph in a 10-year-old child demonstrating a Meyers and McKeever Type III tibial spine fracture. The anterior tibial eminence fragment is completely displaced and rotated superiorly. There is associated hemarthrosis causing joint effusion. The fragment appears to be sitting above the level of the tibial plateau. This degree of displacement requires arthroscopic or open reduction with internal fixation.
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Lateral knee radiograph in a 10-year-old child demonstrating a Meyers and McKeever Type III tibial spine fracture. The anterior tibial eminence fragment is completely displaced and rotated superiorly. There is associated hemarthrosis causing joint effusion. The fragment appears to be sitting above the level of the tibial plateau. This degree of displacement requires arthroscopic or open reduction with internal fixation.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the radiographic findings and Meyers-McKeever classification.

Question 2 (5 marks)

Why does this injury pattern occur in children and what is the mechanism?

Question 3 (6 marks)

Describe the treatment algorithm including surgical technique.

Question 4 (5 marks)

What are the complications and long-term outcomes?

Question 5 (4 marks)

How do you assess ACL function after healing?

Question 6 (4 marks)

What is the role of MRI in these injuries?

Exam Day Cheat Sheet

Must Mention

  • •Meyers-McKeever classification
  • •Pediatric ACL equivalent (bone < ligament)
  • •Type I-II = extension cast, Type III = arthroscopic ORIF
  • •Block to extension = needs surgery
  • •Suture fixation (physeal safe)
  • •Residual laxity common (20-60%)

Common Pitfalls

  • •Wrong classification
  • •Wrong treatment by type
  • •Missing meniscal injury
  • •Wrong fixation choice
  • •Not understanding laxity
  • •Missing block to extension