![]() ![]() Ruptured patellar tendon (arrow) with joint effusion (*) seen in longitudinal view (Figure 3) The patient was ultimately taken to the operating room for an Open Reduction and Internal Fixation (ORIF) by Orthopedic Surgery and discharged home the following day in a knee brace.įigure 1. (Figure 2) X-rays were performed, which confirmed the suspected diagnosis of a left tibial tubercle avulsion. (Figure 1 and Video 1) In addition, there was posterior acoustic shadowing obscuring part of the patellar tendon concerning for an avulsed bony fragment. POCUS of the left knee was performed, which was concerning for a patellar tendon rupture and a joint effusion. The remainder of his physical exam including the neurovascular exam of the affected extremity was otherwise unremarkable. He was unable to fully extend the knee either actively or passively. ![]() On physical exam, he was found to have significant swelling and diffuse tenderness to his left knee extending to his mid-shin, with decreased range of motion of the knee. His initial vital signs were as follows: temperature 37.1 C, blood pressure of 116/85 mmHg, heart rate of 88 beats/minute, respiratory rate of 18 breaths/minute, and oxygen saturation of 99% on room air. He denied any other complaints including head strike or loss of consciousness. He was unable to ambulate after the injury. He had led his jump with his right leg, and then reportedly "felt a pop" in his left knee while midair. Case PresentationĪ 16-year-old male with no significant past medical history presented to the ED with knee pain that began suddenly while playing basketball. 3,4 This case report aims to highlight the utility of point-of-care ultrasound (POCUS) in the rapid diagnosis of traumatic knee pathologies including tibial tubercle fractures in the emergency department (ED). 2 Existing literature on the utility of ultrasound in the diagnosis of this injury is limited to one case report and a single-center study, but does support its use. It is important to diagnose this injury to avoid complications such as compartment syndrome, atrophy of the quadriceps, or loss of knee flexion. 1 It presents as knee pain and occurs more commonly in males, adolescents, and those who participate in athletic activities such as basketball or sprinting. Leily Naraghi, MD, Maimonides Medical Center IntroductionĪ tibial tubercle fracture is an uncommon pediatric fracture accounting for < 1% of epiphyseal fractures and 3% of proximal tubercle avulsion fractures. Irina Sanjeevan, MD, Maimonides Medical Center ![]()
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