What is Tibial Eminence Fracture

Tibial eminence fracture is a break in the top of the shin bone (tibia) at the place where the anterior cruciate ligament (ACL) attaches. Ligaments are bands of fibrous tissue that connect and support bones. The tibia forms the bottom part of the knee joint.

A tibial eminence fracture happens when force on the knee and the ACL cracks a fragment of bone on the surface of the tibia. This may happen when the knee is extended too far, twists too much, or receives a hard, direct hit in the bent position.

There are three types of tibial eminence fractures:

• A type I fracture causes a break in the tip of the tibia but does not move the bone fragment out of place.
• A type II fracture causes a break that is partially out of place.
• A type III fracture causes a break that is completely out of place.

What are the causes?

This condition may be caused by:

• Bicycle collisions and falls.
• Motor vehicle collisions.
• Sports collisions, especially sports that place pressure on the knee, such as skiing.

What increases the risk?

This injury is more likely to happen to children who are 8–14 years of age.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain, especially when moving the knee.
• Swelling.
• Bruising.
• Tenderness.
• Being unable to put weight on the knee.

How is this diagnosed?

This condition may be diagnosed based on:

• Your child’s symptoms and history of injury.
• A physical exam of the knee. Your child’s health care provider will check for tenderness, swelling, and painful or abnormal movement.
• X-rays. An X-ray will usually show the fracture. It may also show blood in the knee joint, which is common with this injury.

How is this treated?

Treatment for this condition depends on the type of fracture. Most type I and some type II fractures can be treated without surgery. Nonsurgical treatment may include:

• Having the knee placed back in position for healing (closed reduction).
• Taking medicines to control pain and reduce swelling.
• Wearing a leg cast to prevent movement for 4–6 weeks.
• Keeping weight off of the injured knee. Your child may need to use crutches or a walker.
• Physical therapy to restore full movement after the cast is removed.

A more severe fracture will require surgery. This includes some type II fractures and all type III fractures. Surgical treatment requires opening the knee (open reduction) or using a small surgical instrument equipped with a scope (arthroscopy) to operate inside the knee.

Follow these instructions at home:

If your child has a cast:

• Do not allow your child to stick anything inside the cast to scratch the skin. Doing that increases your child’s risk of infection.
• Check the skin around the cast every day. Report any concerns to your child’s health care provider.
• You may put lotion on dry skin around the edges of the cast. Do not apply lotion to the skin underneath the cast.
• Do not let your child’s cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do not have your child take baths, swim, or use a hot tub until his or her health care provider approves. Ask your child’s health care provider if your child can take showers. Your child may only be allowed to take sponge baths for bathing.
• If your child’s cast is not waterproof, cover it with a watertight covering when he or she takes a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your child’s skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Have your child gently move his or her toes often to avoid stiffness and to lessen swelling.
• Have your child raise (elevate) the injured area above the level of his or her heart while he or she is sitting or lying down.

Activity

• Have your child return to normal activities as told by his or her health care provider. Ask your child’s health care provider what activities are safe for your child.
• Have your child do exercises as told by his or her health care provider.
• Do not allow your child to use the injured limb to support his or her body weight until your child’s health care provider says that it is okay. Have your child use crutches as told by his or her health care provider.

General instructions

• Do not allow your child to put pressure on any part of the cast until it is fully hardened. This may take several hours.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

How is this prevented?

To help prevent this injury, have your child:

• Warm up and stretch properly before activity.
• Maintain proper conditioning, including strength and flexibility in the thigh, leg, and knee.
• Use proper technique when playing sports.
• Wear proper equipment.

Contact a health care provider if:

• Your child’s pain does not improve or it gets worse.
• Your child has pain, numbness, or coldness in his or her foot.
• Your child’s toes turn blue or gray.
• Your child’s cast becomes loose or damaged.

Tibial Eminence Fracture Fixation, Pediatric

Tibial eminence fracture fixation is a procedure to repair a break (fracture) in the top of the shin bone (tibia) at the place where the anterior cruciate ligament (ACL) attaches. Ligaments are bands of tissue that connect and support bones. The tibia forms the bottom part of the knee joint. Your child may need this procedure if he or she has a break that is partially out of place (type II fracture) or completely out of place (type III fracture).

This surgery may be done through one incision (open surgery) or through two smaller incisions on the sides of the knee using a thin telescope with a camera (arthroscopic surgery). The arthroscope is placed into the knee through one incision, and operating instruments are inserted through the other incision.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to nerves, blood vessels, or other structures in the knee.
• Knee looseness (laxity) or stiffness after surgery.

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

Ask your child’s health care provider about:

• Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do not give your child these medicines before the procedure if your child’s health care provider instructs you not to.
• Your child may have imaging tests to plan the surgery. These tests may include:
  • X-rays.
  • MRI.
  • CT scan.
• Ask your child’s health care provider how your child’s surgical site will be marked or identified.

What happens during the procedure?

• To reduce your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s skin will be washed with soap.
• An IV tube will be inserted into one of your child’s veins. If your child is having open surgery, he or she may be given antibiotic medicine during the procedure.
• Your child will be given a medicine to make him or her fall asleep (general anesthetic). Your child may also be given a medicine to help him or her relax (sedative).
• If your child is having arthroscopic surgery:
  • Two small incisions will be made on each side of the knee.
  • The arthroscope will be inserted through one incision. The camera on the scope will send images to a monitor in the operating room. Your child’s surgeon will view these images to guide the procedure.
  • Surgical instruments will be inserted through the other incision to repair the fracture.
• If your child is having open surgery:
  • One incision will be made in the front of the knee.
  • Knee X-rays may be taken during the procedure.
  • The knee joint will be washed out.
  • Any blood clots or bone fragments will be removed.
• The fractured tibia may be fixed in place using one or more of the following techniques:
  • The tibia may be stitched (sutured) to tissue around rim of the tibia.
  • Holes may be drilled through the edge of the tibia. Then, sutures may be placed through the holes and tied down over the fracture to hold the fracture in place.
  • Screws may be inserted through the fracture.
• The incision or incisions will be closed with sutures, metal clips, or surgical tape.
• A bandage (dressing) will be wrapped around the knee.
• A cast or brace will be placed around the knee to protect and support it during healing.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines your child was given have worn off.
• Your child will be given medicine to help relieve pain.
• If your child is old enough to drive, do not let your child drive until your child’s health care provider says it is safe.

Tell your child’s health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with anesthetic medicines.
• Any blood disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.

Tibial Eminence Fracture Fixation, Pediatric, Care After

This sheet gives you information about how to care for your child after the procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

After the procedure, it is common for your child to have:

• Pain.
• Swelling.
• Bruising.

Follow these instructions at home:

If your child has a brace:

• Have your child wear the brace as told by your child’s health care provider. Remove it only as told by your child’s health care provider.
• Loosen the brace if your child’s toes tingle, become numb, or turn cold and blue.
• Keep the brace clean.
• Keep the brace dry, if it is not waterproof.

If your child has a cast:

• Do not allow your child to put pressure on any part of the cast until it is fully hardened. This may take several hours.
• Do not allow your child to stick anything inside the cast to scratch the skin. Doing that increases your child’s risk of infection.
• Check the skin around the cast every day. Tell your child’s health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Keep the cast clean.
• Keep the cast dry, if it is not waterproof.

Bathing

• Do not have your child take baths or swim until his or her health care provider approves. Ask your child’s health care provider if your child can take showers. Your child may only be allowed to take sponge baths for bathing.
• If your child’s cast or brace is not waterproof, cover it with a watertight covering when he or she takes a bath or a shower.
• Keep your child’s bandage (dressing) dry until his or her health care provider says that it can be removed.

Incision care

• Follow instructions from your child’s health care provider about how to take care of your child’s incision. Make sure you:
  • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your child’s health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your child’s health care provider tells you to do that.
• Check your child’s incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Have your child return to his or her normal activities as told by his or her health care provider. Ask your child’s health care provider what activities are safe for your child.
• If physical therapy was prescribed, have your child do exercises as told by his or her health care provider.
• If your child is old enough to drive, do not let your child drive until your child’s health care provider says it is safe.

Managing pain, stiffness, and swelling

• Have your child gently move his or her toes often to avoid stiffness and to lessen swelling.
• Have your child raise (elevate) the affected area above the level of his or her heart while he or she is sitting or lying down.
• If directed, put ice on the affected area.
  • If your child has a removable brace, remove it as told by your child’s health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your child’s skin and the bag or between your child’s cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

General instructions

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not allow your child to use the injured limb to support his or her body weight until your child’s health care provider says that it is okay. Have your child use crutches as told by his or her health care provider.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has chills or a fever.
• Your child has pain that does not get better with medicine.
• Your child has more redness, swelling, or pain around the incision.
• Your child has more fluid or blood coming from the incision.
• Your child’s incision feels warm to the touch.
• Your child has pus or a bad smell coming from the incision.

Get help right away if:

• Your child has severe pain.
• Your child’s toes:
  • Tingle.
  • Become numb.
  • Turn cold and blue.