Tibial Eminence Fracture

ExitCare ImageA tibial eminence fracture is a fracture of the top of the shinbone (tibia) at the place where the anterior cruciate ligament (ACL) attaches. The fracture may pass all the way through the bone (complete) or pass only part of the way through the bone (partial). The ACL helps the knee joint stay in proper alignment, by preventing the shinbone from moving too far in front of the thighbone (femur). The ACL is important in sports, especially those that require pivoting, changing direction (cutting), jumping and landing. In children, injury to the knee joint is more likely to result in a tibial eminence fracture than a tear of the ACL. An injury that causes a tibial eminence fracture may also cause the ACL to become stretched. Injuries that result in a tibial eminence fracture often include injury to the ligaments on the side of the knee joint (collateral ligaments), or meniscal injury (injury to the joint cartilage).

SYMPTOMS

  • A "pop" or tear, heard or felt at the time of injury.

  • Large knee swelling, almost right away (within 3 hours).

  • Inability to straighten knee.

  • Pain around the knee and difficulty standing on the leg.

  • Knee giving way or buckling, particularly when trying to pivot, rapidly change direction, or jump. Often swelling, while giving way.

  • Sometimes locking, when there is also injury to the meniscus cartilage.

CAUSES

Tibial eminence fractures are caused by force placed on the knee that is greater than the growth plate in the bone can withstand. Tibial eminence fractures may occur after a direct hit (trauma) or non-contact injuries.

RISK INCREASES WITH:

  • Sports that involve pivoting, jumping, cutting, or changing direction (basketball, soccer, volleyball) or contact sports (football, rugby).

  • Poor knee strength and flexibility.

  • Athletes who are under 14 years of age.

  • Improper equipment.

  • Not warming up and stretching properly before activity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain proper conditioning:

  • Thigh, leg, and knee flexibility.

  • Muscle strength and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique when playing sports.

  • Wear proper equipment. (Such as the correct length of cleats for the surface).

PROGNOSIS

When treated properly, tibial eminence fractures usually heal. However, the injury may result in lasting knee looseness and giving way may occur, especially with sports that require pivoting, cutting, jumping and landing.

RELATED COMPLICATIONS

  • Failure to heal (nonunion).

  • Healing in a poor position (malunion).

  • Frequently recurring symptoms, such as knee giving way, instability, and swelling.

  • Injury to meniscal cartilage, resulting in locking and swelling of the knee.

  • Arthritis of the knee.

  • Hindrance of normal bone growth in children.

  • Injury to other structures of the knee (i.e. joint cartilage)

  • Injury to other ligaments of the knee.

  • Knee stiffness, loss of knee motion.

  • Risks of surgery, including: infection, bleeding, injury to nerves (numbness, weakness, paralysis), and need for further surgery (ACL reconstruction).

TREATMENT

Treatment first involves the use of ice and medicine to reduce pain and inflammation. If the fracture is in proper alignment or can be realigned (reduced) without surgery, the knee is restrained for 4 to 6 weeks, to allow for healing. If the bones are not in the proper position, surgery is necessary to realign the bones with pins and screws. After surgery, the knee must be restrained to allow for healing. Strengthening and stretching exercises may be necessary after the period of knee restraint, to regain strength and a full range of motion. These exercises may be done at home or with a therapist. Unless they cause additional pain, the hardware placed in the joint during surgery is not typically removed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve.

  • You experience pain, numbness, or coldness in the foot.

  • Blue, gray, or dark color appears in the toenails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the area of the operation.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)