Proximal Tibial Epiphysis Fracture in a 13-Year-Old Male Athlete

Youth soccer players: patterns of injury involving the primary growth plates of epiphyses

Youth soccer (football) is immensely popular internationally. Earlier participation, sport sub-specialization, and year-around practice have led to an increased incidence of injury from both acute trauma and repetitive overuse. The growth plates (physes) of the immature skeleton are particularly vulnerable to injury and delayed diagnosis can lead to future growth disturbance and long-term morbidity. Familiarity with the various components of the growth plate complex necessary for ensuring normal endochondral ossification is fundamental in understanding the various patterns of imaging findings following injury. This review discusses the zonal columnar arrangement of the growth plate proper and the contrasting function of the vasculature within the subjacent epiphysis and metaphysis. This is followed by an evidence-based discussion of the common patterns of injury involving the epiphyseal primary growth plate observed among youth soccer players: subcategorized into physeal fractures (direct injury) and physeal stress injuries (indirect insult to subjacent metaphysis). In this section, the role of imaging and characteristic imaging features will be discussed. While the normal physiologic and pathophysiologic mechanisms can be applied to other growth plates, such as primary growth plates underlying the apophyses and secondary growth plates surrounding the secondary ossificiation centers, which also undergo endochondral ossification, the current review is focused on injuries involving the primary growth plates underlying epiphyses.

Salter-Harris Type 2 Injury of the Proximal Tibial Epiphysis in a 15-year-old Athlete: A Rare Case Report

Background

Proximal tibial epiphyseal injuries in adolescents are uncommon accounting to 0.5 to 3 % of all epiphyseal injuries. Although rare, the proximity of popliteal artery puts this region at an increased risk of vascular injury and compartment syndrome. Also, premature closure of the growth plate can cause restrictions in growth and angular malformations. The fractures may often be missed on routine X-rays. Frequent monitoring and further testing should be done to better diagnose these injuries.

Case History

We present a case of an adolescent football player (15 years old) who injured his left knee and was diagnosed to have Salter- Harris II proximal tibial epiphyseal injury. Routine radiographs revealed minimal widening in his epiphysis anteriorly when compared to his contralateral knee. Magnetic resonance imaging (MRI) findings revealed a fracture passing through the growth plate of proximal tibia exiting posteriorly into the tibial metaphysis. Management included closed manipulation and plaster cast immobilization with regular follow-ups. At the end of 1.5 years, the patient had full range of motion without any residual deformities.

Conclusions

High clinical suspicion is required to diagnose these rare injuries. When in doubt, MRI is advocated to better delineate the fracture as the potential complications can be limb threatening. Anatomical reduction and adequate immobilization should be done to prevent deformities and good functional outcome in the long term.

[Bony knee injuries in childhood and adolescence]

While fractures around the knee are known to be rare, physicians have encountered a rise in the frequency due to the increased participation of children and adolescents in high-impact sports at a younger age. Even if the treatment of fractures in some cases resembles that in adults, the diagnostics and treatment in childhood and adolescence require a hígh level of experience in order avoid possible sequelae and to enable early recognition. Thorough diagnostics using clinical and imaging investigations as well as a precise weighing up of the treatment are essential to minimize differences in leg length and axial malpositioning of the leg. A decision between conservative and operative treatment is made for both the femur and tibia depending on the type of fracture. Decisive is the degree of dislocation of the fracture. In operative treatment, the axis conform reduction and subsequent stress stable treatment are particularly decisive. Avulsion trauma, bony avulsions of the intercondylar eminence and patellar injuries are also treated conservatively with immobilization or surgically with the aid of various fixation techniques, depending on the degree of dislocation.

Rehabilitation of simultaneous bilateral epiphysial fracture of proximal tibia in adolescent

Simultaneous and bilateral epiphysial fracture of the proximal tibia is an extremely rare injury, with only 23 cases reported in the literature. In this paper, we present a 15-year-old adolescent with a simultaneous and bilateral epiphysial fracture of the proximal tibia in sport context (trampoline jump). He underwentsurgical repair with bilateral closed reduction and internal fixation, followed by outpatient rehabilitation programme during 4 months. There was a good functional outcome, without limitation in activities of daily living and with resumption of amateur sports activity. Since there are no guidelines described for this pathology, the authors suggest a rehabilitation protocol for bilateral epiphysial fractures of the proximal tibia that underwent surgical treatment previously and in which there were no complications in the acute phase.