Fractures in children: tibial spine avulsion: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures in children: tibial spine avulsion

Sample item

A 10-year-old falls off a bicycle and has a haemarthrosis with a positive Lachman test. A radiograph shows an avulsed fragment from the intercondylar eminence of the tibia. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Tibial spine avulsion, the equivalent of an ACL injury in the skeletally immature

In children the ACL attachment is stronger than the immature bone, so the tibial eminence avulses instead of the ligament rupturing. Displaced fragments are reduced and fixed, and undisplaced ones are casted. A Segond fracture is a lateral tibial plateau avulsion in adults.

Option by option

  • A. Segond fracture

    Segond fracture is a lateral capsular avulsion in adults.

  • B. Patellar sleeve fracture

    Patellar sleeve fracture presents with a high-riding patella and extensor loss.

  • C. Osgood-Schlatter disease

    Osgood-Schlatter disease is traction apophysitis of the tibial tubercle without haemarthrosis.

  • D. Tibial spine avulsion, the equivalent of an ACL injury in the skeletally immature (correct)

    Correct. The eminence avulses in children in place of an ACL tear.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Tibial spine avulsion, the equivalent of an ACL injury in the skeletally immature. In children the ACL attachment is stronger than the immature bone, so the tibial eminence avulses instead of the ligament rupturing.

Why is "Segond fracture" not the answer?

Segond fracture is a lateral capsular avulsion in adults.

Why is "Patellar sleeve fracture" not the answer?

Patellar sleeve fracture presents with a high-riding patella and extensor loss.

Why is "Osgood-Schlatter disease" not the answer?

Osgood-Schlatter disease is traction apophysitis of the tibial tubercle without haemarthrosis.

What concept does this question test?

It tests Fractures in children: tibial spine avulsion in Orthopaedics. Displaced fragments are reduced and fixed, and undisplaced ones are casted. A Segond fracture is a lateral tibial plateau avulsion in adults.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures in children: tibial spine avulsion?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.