UMEM Educational Pearls

Title: What's the Diagnosis? Written by Zachary Dezman

Posted: 12/2/2012 by Haney Mallemat, MD (Updated: 12/3/2012)
Click here to contact Haney Mallemat, MD

Question

11 year-old boy presents with right knee pain and swelling after falling off of his bicycle. What's the diagnosis?

Answer

Answer: Fracture of the intercondylar eminence of the tibia; Meyers & McKeever Grade II (grading system described below)

Intercondylar Eminence Fracture

Avulsion of the insertion of the ACL because the ligament stronger than incompletely ossified bone in children
Incidence is 3 in 100,000 children
Most common injury mechanism
- Falls from a bicycle
- Motor vehicle crash
Meyers and McKeever’s classification system
- I (non-displaced) - Generally treated non-operatively with long-leg casting
- II (hinged fragment) - Generally treated like Grade I
- III (displaced) - Requires surgical fixation

Reference: Tudisco, C., et al Intercondylar eminence avulsion fracture in children: long-term follow-up of 14 cases at the end of skeletal growth, J Pediatr Orthop B 19:403–408 c 2010

References

Follow me on Twitter (@criticalcarenow) or Google+ (+haney mallemat)