Musculoskeletal case studies for medical students

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A seven year old boy injured himself during a football match.

He had swelling over the proximal tibia.

Initial X ray
Description AP X ray
X ray
Description Lateral X ray
Problem The boy who injured his knee during a soccer match.
X ray after treatment
Description Lateral X Ray after ORIF
Post management further view
Description AP X ray after ORIF
Classification The lateral x ray (on previous page) shows the tibial spine has been avulsed. Notice that the patella is high riding - the patella and its tendon should be of equal length.
Discussion of management

The tibial apophysis can be avulsed by the patella tendon. The severity can cary from a small anterior avulsion, to complete separation of the apophysis with the whole growth plate. A patellar tendon rupture is also a possibility i these types of injury. Make sure that the injury is not an old one. Osgood Schlatter's disease is a chronic partial separation of the tibial spine (apophysis). Ask the patient about pre existing patellar pain and look for signs of chronicity on the x ray (rounded fracture edges, callus etc.). Osgood Schlatters's is usually treated conservatively.

This is a fresh injury. The avulsed tibial spine needs internal fixation. If you practice away from a suitable facility, splint the limb in a back-slab and refer to an Orthopaedic Surgeon.


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