Knee & Shoulder Surgeon - Orthopedic Specialist
Knee & Shoulder Surgeon - Dr. Amyn Rajani
M.S Orth (Gold Medallist), D-Orth, MBBS
Knee and Shoulder Surgeon
(Arthroscopy & Joint Reconstruction)
Orthopaedic Arthroscopy Knee & Shoulder Clinic (OAKS)

Fracture of Tibial Spine

Introduction :
Between the articular facets of the tibia, but nearer the posterior than the anterior aspect of the bone, is the intercondyloid eminence (spine of tibia). The tibial spine is surmounted on either side by a prominent tubercles. In front of and behind the intercondyloid eminence are rough depressions for the attachments of the anterior and posterior cruciate ligaments and the menisci.

Background :
It is one of the most common knee injuries in children between the ages of 8-14 yrs. The fragment of tibial spine may be non displaced, or displaced. Incomplete or complete fractures of the tibial spine may be associated with partial ACL injury. Fractures of posterior intercondylar eminence are rare and usually occur in skeletally mature patients. They may be associated with disruption of PCL.

Mechanism of injury :
Tibial spine fractures are caused by forceful hyperextension of knee or by a direct blow on distal end of femur with the knee flexed. Excessive tension on ACL, which inserts into anterior tibial spine, results in an inter-articular fracture.

Classification :
Type I

tibial spine avulsion fracture

Non-displaced fracture with only the anterior edge of eminence being elevated
Type II

intercondylar eminence fracture

Partially displaced fracture with only anterior elevation of the eminence
Type III

tibial spine avulsion fracture

Completely displaced fracture with the entire eminence lying above its bed, out of contact with the tibia

Clinical features :
» Pain
» Swelling
» Inability to bear weight
» Signs of cruciate ligament tears

Investigations :
X-Rays :
Anterior-posterior view and lateral views of the knee are advised.

Conservative management :
It is indicated in undisplaced or minimally displaced fractures.
Immobilization of the limb with knee in 20 deg of flexion, as ACL is most relaxed in this position four 4 to 6 weeks.

Surgical management :
It is indicated for displaced fractures.
Fixation of the tibial spine is done under the guidance of knee arthroscopy

Complications :
Laxity :
» May be due to stretching of the ligament at the time of injury.
» Laxity is rarely severe enough to limit activities or requires treatment.

Malunion :
This may result in a flexion deformity of the knee


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