Minor Assessment Area
 
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Child on bed
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1. What's the diagnosis?
There is an avulsion fracture involving the tibial tuberosity. On the Watson-Jones classification this is probably a type II B fracture as it does not involve the joint (no lipohaemarthrosis and comminuted).

2. Would you expect to see a lipohaemarthrosis?
You might until you remember your anatomy and think about the synovial reflections around the tibial plateau. The anterior parts reflect back around the cruciates so these injuries do not always involve the synovial cavity. If they do they are a type III fracture.

3. What's the management?
Firstly analgesia. This is painful and is going to get worse. Not one for just paracetamol. We would advocate intranasal diamorphine.

Secondly analgesia. Get it splinted to prevent movement.

Them, this is one for the orthopods. It will require internal fixation to get the fragments back into position.

http://emedicine.medscape.com/article/1250197-overview