Case Study – Tibial Spine Fracture

August 6, 2017 | By | Reply READ MORE...

– Vrutti Panchal

Mr. X, a 35 year old male came to PhysioRehab with the following complaints:

  • Inability to straighten right knee completely
  • Mild pain on posterior part of knee
  • Discomfort in sitting for long hours with knees bent

HISTORY:

  • The onset of pain started when he had a fall from active in November 2016.
  • After the fall he was in plaster for two and half months with knee in flexed position and for that physiotherapy treatment was taken at Bhatia hospital.

AGGRAVATING FACTORS:

  • Prolonged sitting with knees bent, ascending stairs and getting up after sitting prolonged at office.

RELIEVING FACTORS:

  • Rest and lying down with knees straight.

EXAMINATION:

Posture –

  • Male with upper heavy body
  • Rounded shoulders
  • Slightly bulging abdomen
  • Bilateral pronated feets

Range of motion –

  • Knee AROM Flexion-120(right)
  • Knee AROM Extension-lag of one and half finger
  • Hip AROM-Full, pain free

Muscle Strength –

  • Testing demonstrated that his quadriceps were weak(right>left)
  • His gmax (rt)-2+ and (lt)-3 and gmed(rt)-4 and (lt)-4+and his quads were also comparatively weak(right>left)(3+>4)

Muscle Tightness –

  • Mild Tightness present in left hamstrings and right gastrocnemius muscle
  • There is right posterior capsule tightness also present
  • No neurological symptoms were present on examination

PT Diagnosis –

Right Extensor lag Post-Tibial Spine Fracture

What is Tibial Spine Fracture?

  • Tibial spine fractures are ACL equivalent injuries, and should be operatively managed if displaced
  • The meniscus and intermeniscal ligament can be barriers to reduction
  • Although ACL laxity can commonly occur due to ligamentous stretch during injury, this laxity is rarely clinically significant if the fracture is properly treated

Description –
Tibial spine fractures are relatively uncommon injuries that typically occur at the base of the tibial spine. While these injuries can occur in adults, they are more common in skeletally immature patients between ages 8-14. These injuries can occur during sporting endeavors. They have classically been associated with a hyperextension injury to the knee as a result of a bike accident. The injury creates traction forces along the anterior cruciate ligament (ACL) and causes avulsion of the tibial spine. The immature tibial spine is weaker than the ACL. Prompt recognition and management of these injuries can decrease morbidity and minimize long term complications.

Anatomy –
The term tibial eminence refers to the area between the medial and lateral tibia plateaus on the proximal tibia, and consists of the medial and lateral tibial spines. The ACL inserts on the medial tibial spine. Tibial spine fractures occur through the subchondral bone at the base of the medial tibial spine and are ACL equivalent injuries.  The fracture may extend into the medial and lateral tibial articular surfaces.

Clinical Presentation –
Patients who sustain these injuries typically present with a painful hemarthrosis and the inability to fully extend their knee.

TREATMENT:

  • Postural awareness – Patient was educated about correct postural alignment and its importance.
  • Stretching – Hamstring and calf trenching was done to reduce the tightness and also Posterior capsule stretch was given in prone with one kg weight to reduce the extension lag.
  • Strength Training.
  • Posterior capsule stretch was given in prone postion with to improve the extension lag and also in standing.

  • Glut activation was trained to improve the strength and endurance in weight bearing position as well as to avoid knee overloading.
  • As he was pain free we started with weight training exercise to improve the muscle strength, muscle mass and endurance with one kg weight.

  • Eccentric quadriceps exercise were performed.
  • Post pain levels reduced, foot assessment was done with orthotic fitting, which helped to improve biomechanical alignment and increase to weight bearing.

OUTCOME:

  • Post two months of regular physiotherapy (twice a week), he showed improvement in his strength of quadriceps muscles due to which walking pattern(less limping) improved.
  • Patient was able to perform exercise in functional position. He could perform exercise at home and also go for his walks with the orthotic insoles given to him with minimal discomfort.
  • Patient reported to have decreased pain after the regular exercise performed by him everyday and also could sit and get up comfortably from his office chair without any pain or discomfort.

An individualized, tailor-made exercise regime at PhysioRehab helped Mr. X to achieve better quality life.

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Category: Case Studies

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