Pediatric Cartilaginous Tibia Eminence Fracture Overlooked on Plain Radiograph: A Report of Two Cases

Seong-Eun Byun; Yunseong Choi; Wonchul Choi

doi:10.12671/jkfs.2017.30.1.29

Journal List > J Korean Fract Soc > v.30(1) > 1038113

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Byun, Choi, and Choi: Pediatric Cartilaginous Tibia Eminence Fracture Overlooked on Plain Radiograph: A Report of Two Cases

Case Report

Journal of the Korean Fracture Society 2017; 30(1): 29-34.

Published online: 20 January 2017

DOI: https://doi.org/10.12671/jkfs.2017.30.1.29

Pediatric Cartilaginous Tibia Eminence Fracture Overlooked on Plain Radiograph: A Report of Two Cases

Seong-Eun Byun, M.D., Yunseong Choi, M.D., Wonchul Choi, M.D., Ph.D.

Department of Orthopaedic Surgery, Bundang CHA Hospital, CHA University, Seongnam, Korea.

Correspondence to: Wonchul Choi, M.D., Ph.D. Department of Orthopaedic Surgery, Bundang CHA Hospital, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: +82-31-780-5289, Fax: +82-31-708-3578, wcchoios@chamc.co.kr

Received 15 November 2016 Revised 11 December 2016 Accepted 27 December 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In children with open physis, avulsion fracture of the tibia eminence, as an anterior cruciate ligament (ACL) injury, is more commonly observed than an ACL rupture. Pure cartilaginous avulsions of the ACL tibia insertion seldom occurs. In such case, cartilaginous lesion is frequently overlooked or misdiagnosed on plain radiograph and may result in a less favorable treatment outcome. We report two cases of cartilaginous tibia eminence fractures of the children that were initially overlooked from plain radiographs, and then diagnosed by magnetic resonance imaging, which was ultimately treated by arthroscopyassisted headless compression screw fixation.

Keywords: Child, Anterior cruciate ligament, Tibia eminence fracture, Cartilaginous, Magnetic resonance imaging, Headless compression screw

Figures and Tables

Fig. 1

Initial both knee anteroposterior and lateral plain radiograph images show no definite sign of bony fracture. Rt: right, Lt: left.

Fig. 2

Preoperative right knee magnetic resonance imaging image shows fractured cartilaginous fragment attached to the anterior cruciate ligament (arrow).

Fig. 3

(A) Arthroscopic finding via anterolateral portal shows displaced fracture fragment. (B) Fragment is raised by a probe and fracture between cartilage and subchondral bone was identified.

Fig. 4

Follow-up plain radiographs taken at 3 years after the operation shows healed fracture without any sign of screw loosening or leg length discrepancy.

Fig. 5

The existence of thin ossification (arrows) inside the right knee joint is suspected from the initial both knee anteroposterior and lateral plain radiograph images. Rt: right, Lt: left.

Fig. 6

Preoperative right knee magnetic resonance imaging shows disrupted proximal tibia articular cartilage continuity with fluid signal between cartilage and subchondral bone (arrow).

Fig. 7

(A) Arthroscopic finding via the anterolateral portal shows avulsed fracture of anterior cruciate tibia insertion. (B) Fracture reduction is maintained with an aid from the anterior cruciate ligament tibial guide and was held with a Kirschner wire.

Fig. 8

Follow-up plain radiographs taken at 1 year and 6 months after the operation show a healed fracture without any signs of screw loosening or growth disturbance. Rt: right, Lt: left.

Notes

^{Financial support} None.

^{Conflict of interests} None.

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