Proximal Tibial Epiphyseal Fracture, Complete Separation: A Rare Occurrence

Abstract

Introduction: Dislocation of the knee joint and fractures about the proximal tibia are extremely rare occurrences in the paediatric age groups. Based on the Salter and Harris classification system, we present a case of Type 1 fracture of the proximal tibia with complete separation of the epiphysis. The case also highlights the presence of other concomitant injuries that accompany the trauma around the knee. Case Report: An 8 year old male child was brought to the casualty of the hospital after sustaining injury to the knee while playing soccer at school. He was struck from front by another kid and immediately fell with extreme pain in the knee. He presented to us after a delay of 2 hours post injury. On arrival there was gross swelling of the knee joint and also the leg involving the foot. The distal pulsations were feeble but palpable. Toe movements were limited. Immediate radiological assessment revealed a fracture involving the proximal tibia. Patient was found to have signs of impending compartment syndrome. Emergency surgery was taken up in presence of a vascular surgeon, the fracture reduced, vascularity preserved and fasciotomy done. Child was discharged after a stay of 20 days with good range of movements at the knee joint. Conclusion: The rarity of the proximal knee injuries, combined with neuro vascular damage render this area a perilous zone in paediatric orthopaedics. However prompt intervention leads to good functional recovery and early mobilization.