Knee Injury - Football

HISTORY: 14 year old linebacker playing in a JV football game presents to the emergency department with a left knee injury when another player landed on his left leg. His left leg was planted forward and extended at the knee. The other player landed directly onto his lower leg. He had immediate pain and deformity. He was splinted by the athletic trainer on the field transported to the nearest emergency department. He was given nitrous oxide for pain control by EMS. PHYSICAL EXAM: On arrival in the ED he has obvious deformity to the knee with apparent sunken appearance of the lower leg compared to the upper leg. His pedal pulse was strong and he had goo capillary refill. Able to move his toes and foot. Significant effusion noted with associated tenderness. DIFFERENTIAL DIAGNOSIS: 1. Knee Dislocation 2. Distal Femur Fracture 3. Proximal Tibia Fracture TESTS AND RESULTS: X Ray of Left Knee AP, Oblique, Lateral Views:Acute comminuted and displaced tibial tuberosity avulsion fracture with involvement of the epiphysis and physis. FINAL DIAGNOSIS: Traumatic Avulsion Fracture of the Tibial Tuberosity TREATMENT AND OUTCOMES: 1. Transferred to local pediatric trauma center after consultation with orthopedics. 2. Underwent ORIF the following day with three cannulated screws. 3. He recovered well after surgery and was discharged the same day as his operation. 4. He has progressed well at subsequent follow ups and continues to follow with pediatric orthopedics.