Presentation
The patient fell off a stepladder and presented with left knee swelling, bruising and inability to weight bare.
Patient Data
Features consistent with a left tibial tuberosity avulsion fracture injury. There is pretibial soft tissue swelling, an expected high riding patella (patella Alta), supra and infra patellar bursal distension and likely effusion/hemarthrosis. There is background osteopenia and degenerative change. The contralateral and asymptomatic right knee is intact.
The limited portable, supine, post-operative image confirms open reduction and internal fixation of the tibial tuberosity avulsion fracture injury. There are two, somewhat perpendicular, partially-threaded, cannulated, cancellous screws with washers fixating the tibial tuberosity. There is a supporting knee brace in situ.
Case Discussion
This elderly patient lost her balance and fell off a step ladder and landed with force (violently) and hence sustained the tibial tuberosity avulsion fracture. She underwent open reduction and internal fixation a few days later and had an unremarkable post-operative period.
Tibial tuberosity avulsion fracture injuries are rare injuries often sustained during landing from a jump or jumping from a fixed foot. Basketball is the most common sporting activity during which these types of avulsion injuries are sustained. Theoretically, any sporting activity that requires jumping/ landing may represent a source of the mechanism of injury including parachuting, hand gliding, jumping sports(triple jump, long jump, pole vaulting, high jump) etc.
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