The intra-articular portion of the upper tibial surface, called tibial eminence, consists of two spines: medial and lateral. The anterior cruciate ligamentis attached to the medial spine, whereas lateral spine has no attachment to any other structure.⁴ Tibial spine avulsion fractures (intercondylar eminence fractures) are most commonly faced in young patients between 8 and 14 years of age.^1,2 Though such fractures in paediatric patients are rare injuries, they account for 14% of all anterior cruciate ligament (ACL) injuries in the same age group.³  The mechanism of injury is hyperextension of the knee with simultaneous rotation of the knee on the tibia, as may happen while falling off a bicycle, playing soccer or participating in other forceful sports related activities. Significant tension is put on the ACL, while doing hyperextension of knee.⁵ As the ACL originates on the lateral femoral condyle and inserts onto the anterior tibial spine, The forceful hyperextention results in an avulsion fracture of the tibial attachment site and this also leads to weakness in the cruciate ligament. The bone fails before the ligaments as per their elastic property and, hence, these fractures are common in children than in adults. The tibial spine fractures are classified [Meyer and McKeever] into three types: type 1 fracture is undisplaced; type 2 is partially displaced or hinged; and type 3 is completely displaced or inverted and impossible to reduce because of the transverse meniscal ligament preventing seating of the fragment.⁶A type IV is also described by Zaricznyj⁷, which represents rotation and comminution of the fragments.

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Dr Bhargav A. Desai

3rd Year Resident Dept of Orthopedics, V.S. Hospital, Ahmedabad