The Management of Tibial Spine Avulsion Fracture in a Skeletally Immature Patient by Using Staple Fixation: A Case Report

Tibial spine (TS) fractures are uncommon injuries in children and typically occur after sports-related trauma or road traffic accidents. We report the case of an 11-year-old male who presented with severe pain, swelling, and an inability to move the left knee after a direct impact during a road traffic accident. Initial radiographs demonstrated a displaced TS fracture. CT confirmed an avulsion fracture at the anterior cruciate ligament (ACL) tibial insertion with intra-articular incarceration of the fragment. MRI showed bone contusions and an avulsed ACL insertion without disruption of the ACL fibers. Given the complexity of the displaced fracture pattern, surgical treatment was performed. Open reduction and internal fixation were performed using permanent staples positioned to avoid crossing the physis, and intraoperative imaging confirmed anatomic reduction and stable fixation. At the three-month follow-up, radiographs demonstrated satisfactory healing with a clinically stable knee. This report highlights a physeal-sparing fixation strategy employing staples for a complex pediatric TS fracture.