Tibial spine fracture with anterior cruciate ligament avulsion - type 4

Case contributed by Jeremy Jones


Football injury with hyperextension and direct trauma. Unable to weightbear.

Patient Data

Age: 14 years
Gender: Male

The lateral radiograph clearly demonstrates a fracture of the tibial spine with the fracture fragment in the joint space.

The large tibial spine avulsion is clearly demonstrated on the CT. There is a separate incidental fibrous cortical defect.

Case Discussion

The ACL has been avulsed from its tibial insertion with multiple fragments of bone. ACL avulsion injuries can be classified into four different types - this is a type 4 injury. In addition, there is a fibrous cortical defect of the medial cortex of the proximal tibia.

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