Fractures of the Tibial Spines and Tuberosity

Although isolated injuries of the tibial spine are uncommon, they usually result in cruciate ligament insufficiency. The injury is most often caused by a force directed against the flexed proximal tibia in an anterior or posterior direction, resulting in incomplete avulsion of the tibial spine, with or without displacement, or complete fracture of the spine. Vehicular and sporting accidents are the most common causes of these injuries.7 Fracture of the anterior tibial spine is about tenfold more common than fracture of the posterior spine. Examination shows a painful, swollen knee, secondary to hemarthrosis, inability to extend fully, and a positive Lachman's sign (see section on Ligamentous and Meniscal Injuries). If the fracture is incomplete or nondisplaced, it should be immobilized in full extension in a knee immobilizer. Protected weight bearing and outpatient orthopedic follow-up within a few days to a week is advised. Complete, displaced fractures require early orthopedic consultation and often need open reduction, and internal fixation.

The quadriceps mechanism inserts on the tibial tubercle. A sudden force to the flexed knee with the quadriceps muscle contracted may result in a complete or incomplete avulsion of the tibial tubercle. The fracture line may extend into the joint. Examination reveals pain and tenderness over the proximal anterior tibia with pain on passive or active extension. If the avulsion is small or nondisplaced, the fragment may be maintained in position by immobilization; otherwise, open reduction and internal fixation are necessary.7 (See also section on Injuries to Tibial Tubercle.)

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