Proximal tibial physis fracture and popliteal artery injury

Bilateral epiphyseal fractures of the proximal tibia within a six-month interval: a case report

An epiphyseal fracture commonly results from avulsion of the epiphysis by traction through the attached ligaments. A fracture of the proximal tibial epiphysis is, therefore, a rare injury because of the absence of collateral ligament attachments. Most proximal tibial epiphyseal injuries occur as avulsion fractures of the tibial tubercle; Salter-Harris Types I or II injuries involving pressure epiphyses are rare. In the current case of a thirteen-year-old boy, the proximal tibial epiphyseal injuries in both knees occurred during quadriceps contraction in the absence of violent trauma, and there was a six-month interval between the two injuries.

Trauma involving the proximal tibial epiphysis

Thirty injuries involving the proximal tibial epiphysis were treated during a period of 28 years. The epiphysis was displaced in 16 cases (53%). Three patients presented with peripheral ischemia on admission, and one patient with associated ipsilateral femoral fracture developed delayed thrombosis of the popliteal artery. The treatment results were satisfactory in 21 of the 27 (74%) who were reassessed according to Shelton's evaluation criteria after an average post-traumatic interval of 11.6 years. Three of the six patients with unsatisfactory outcome had a discrepancy in leg length of more than 2.5 cm after concomitant ipsilateral fracture of the femur or the tibia. One patient had a positive 3-cm anterior drawer sign, one patient had a 10 degree valgus deformity of the tibia, and one had to undergo above-knee-amputation because of delayed diagnosis of the vascular lesion.