Tibial eminens avulsiyonu

Özet

Tibial eminens avulsiyonu, özellikle büyüme plağı açık çocuk ve ergenlerde ön çapraz bağın tibial yapışma yerinden kemik fragman kaldırmasıdır; erişkinde bağın kendisi yırtılabilir. BT, fragmanın kemik anatomisini, yer değiştirmesini, rotasyonunu ve eklem yüzü uzanımını düz grafiden daha ayrıntılı gösterir. Fragman yükselmesiyle terminal ekstansiyon kaybı görülebilir; eşlik eden menisküs sıkışması, ACL liflerinin devamlılığı ve diğer yumuşak doku yaralanmalarının değerlendirilmesinde MRG daha uygundur. Küçük ya da posterior menteşesi korunmuş kırığın atlanması, deplasmanın ve eklem içi engelin eksik tanımlanmasına yol açabilir.

Faz ve pencere

Kontrastsız tanısal

İnterkondiler eminens tabanından ayrılan kemik fragman, yükselme/rotasyon, posterior kemik menteşesinin devamlılığı ve eklem yüzüne uzanan kırık hattı değerlendirilir.

Kemik algoritması tanısal

Düz grafilerde posterior menteşenin bütünlüğü her zaman net seçilemeyebilir; bu durum Meyers–McKeever Tip II ile Tip III ayrımını güçleştirebilir.

BT bulguları

• İnterkondiler eminens tabanında kırık hattı ve tibial yapışma alanından ayrılmış fragman.
• Anterior fragman elevasyonu; posterior menteşe sağlam kalabilir veya tam ayrılmada kaybolabilir.
• Fragmanın ekseni ve rotasyonu; dönen kemik parçası eklem aralığına doğru yönelmiş olabilir.
• Kırık hattı proksimal tibial fizise ya da tibial plato/kondil eklem yüzüne uzanabilir; eşlik eden plato kırığında eklem yüzü basamağı gelişebilir ve bu eşlik eden kırıkların BT ile tanımlanması gerekir.
• Parçalı fragman veya eminensin birden fazla kemik bileşenine ayrılması.
• Eklem efüzyonu/hemartroz ve çevre yumuşak doku şişliği eşlik edebilir; menisküs interpozisyonu BT'de güvenle dışlanamaz.
• İskelet olgunlaşmamış hastalarda ACL yaralanmaları sıklıkla tibial eminens avulsiyonu biçiminde görülür; iskelet olgunlaştıkça ACL'nin bağ içi yırtığına geçiş eğilimi olduğundan yaş ve fizis görünümü birlikte yorumlanır.

Ölçütler ve sınıflamalar

Meyers–McKeever sınıflaması (Zaricznyj modifikasyonu)

Tip I: ayrışma yok ya da minimal. Tip II: anterior fragman yükselmiş, posterior menteşe korunmuştur. Tip III: fragman eminens tabanından tamamen ayrılmıştır. Tip IV: parçalı (komminüt) kırık.

Normalde

Normal interkondiler eminens tibial plato ortasında düzgün, kesintisiz kortikal yükselti oluşturur; tabanında ayrılmış kemik parçası veya eklem içine kalkmış fragman bulunmaz. Bir olgu raporunda, karşılaştırmalı ön-arka ve lateral grafilerde tibial interkondiler eminensin hafif elevasyonu görülmüştür.

Ayırıcı tanı

Tibial eminens gelişimsel düzensizliği

düzgün kortike ve yaşa uygun kemikleşme görünümü verir; akut ayrışma hattı ve eklem efüzyonu beklenmez.

Tibial plato kırıkları—özellikle Schatzker IV—kondil eklem yüzü veya metafiz boyunca uzanır; izole eminens avulsiyonundan farklıdır.

ACL bağ içi yırtığı, tibial eminens avulsiyonundan farklı bir ACL yaralanma biçimidir; ACL liflerinin devamlılığı MRG ile değerlendirilir.

Osteokondral fragman femoral kondil veya troklear bölgeden kaynaklanabilir; bu yerleşim, ACL'nin tibial yapışma yerinden ayrıldığı tibial eminens avulsiyonundan farklıdır.

Tuzaklar

• Posterior menteşe bütünlüğü tek düzlemde net olmayabilir; ardışık sagittal ve koronal kesitlerde fragman arka tabanı doğrulanmalıdır.
• Küçük elevasyonu küçümseme; fragmanın eklem aralığına doğru kalkması mekanik takılma oluşturabilir ve sınıflama için menteşe ilişkisi önemlidir.
• Tibial eminens avulsiyonu ACL'nin sağlam olduğunu tek başına göstermez; ACL liflerinin devamlılığı ve eşlik eden menisküs sıkışması MRG ile değerlendirilebilir.
• Çocukta fizis ve kemikleşme merkezini kırıkla karıştırma; karşı tarafın aynı yaş düzeyindeki konturu ve akut donör yatağı yardımcıdır.
• Tibial eminens avulsiyonları, çocuk ve ergenlerde ACL yaralanmasının ayrı bir biçimidir; ACL liflerinin devamlılığı ve eşlik eden menisküs ya da osteokondral yaralanmalar MRG ile değerlendirilebilir.

Kendini dene

1. Fragmanın ön kısmı yükselmiş, arka tabanı tibia ile bağlantısını koruyor. Meyers–McKeever tipi hangisidir?

   • Tip II
   • Tip I
   • Tip III
   • Tip IV
   Cevabı göster

   Tip II. Tip II'de anterior elevasyon ve sağlam posterior menteşe birlikte bulunur. Tip I'de deplasman yok/minimaldir; Tip III tam ayrılma, Tip IV parçalı ya da rotasyonlu tam ayrılmadır.

2. Zaricznyj modifikasyonuna göre komminüt tibial eminens kırığı hangi tiptir?

   • Tip IV
   • Tip II
   • Tip IIIA
   • Tip I
   Cevabı göster

   Tip IV. Zaricznyj modifikasyonunda Tip IV, komminüt tibial eminens avulsiyon kırıklarını tanımlar.

İlgili konular

• Diz lipohemartrozu
• Tibia platosu posterior shear/kolon kırığı
• Segond avulsiyon kırığı

Kaynaklar

Bu sayfadaki 40 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 10 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Tibial Spine Avulsion Injuries in Children and Adolescents: A Narrative Review of Anatomy, Management Strategies, and Return-to-Sport Considerationspmc.ncbi.nlm.nih.gov
2. Blunt Cardiac Rupture: A Diagnostic Challenge.pubmed.ncbi.nlm.nih.gov
3. The Effect of Bony Parameters on the Pediatric Knee: Normal versus Anterior Cruciate Ligament Injury versus Tibial Spine Avulsion Fracture.pubmed.ncbi.nlm.nih.gov
4. Arthroscopic ACL Tibial Spine Avulsion Fixation Using Suture Pull-Through Double-Tunnel Technique.pubmed.ncbi.nlm.nih.gov
5. The Management of Tibial Spine Avulsion Fracture in a Skeletally Immature Patient by Using Staple Fixation: A Case Report.pubmed.ncbi.nlm.nih.gov
6. Simultaneous Anterior Cruciate Ligament Avulsion Fracture with Bilateral Posterior Meniscal Root Tears of the Knee: A Case Report.pubmed.ncbi.nlm.nih.gov
7. Intercondylar eminence fracture treated by resorbable magnesium screws osteosynthesis: A case series.pubmed.ncbi.nlm.nih.gov
8. A Rare Combination of Avulsion Fractures Around the Knee -A Case Report.pubmed.ncbi.nlm.nih.gov
9. Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients.pubmed.ncbi.nlm.nih.gov
10. High-speed electric-scooter crash causing a tibial spine fracture with physeal extension in an adolescent: a case report.pubmed.ncbi.nlm.nih.gov
11. The Medial Malleolar Fleck Sign: A Case Report Highlighting Retinacular Origin Rather Than Deltoid Ligament Avulsion.pubmed.ncbi.nlm.nih.gov
12. Tibial Spine Avulsion Injuries in Children and Adolescents: A Narrative Review of Anatomy, Management Strategies, and Return-to-Sport Considerations.pubmed.ncbi.nlm.nih.gov
13. Complications Leading to Reoperation After Pediatric Tibial Spine Fracture Fixation.pubmed.ncbi.nlm.nih.gov
14. ACL injuries in skeletally immature athletes.pubmed.ncbi.nlm.nih.gov
15. Medial Tibial Plateau Fractures and Fracture-Dislocations: A Mechanism-Based Narrative Review of Instability Patterns, Imaging, and Contemporary Management.pubmed.ncbi.nlm.nih.gov
16. PlaTiF: A pioneering dataset for orthopedic insights in AI-powered diagnosis of tibial plateau fractures.pubmed.ncbi.nlm.nih.gov
17. Current concepts review. Management of proximal tibial fractures.pubmed.ncbi.nlm.nih.gov
18. Advances in repair of non-discoid meniscus injuries in children: a narrative review.pubmed.ncbi.nlm.nih.gov
19. Current concepts in the management of high-energy tibial plateau fractures: a narrative review.pubmed.ncbi.nlm.nih.gov
20. Comparing MRI and arthroscopic appearances of common knee pathologies: A pictorial review.pubmed.ncbi.nlm.nih.gov
21. Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures.pubmed.ncbi.nlm.nih.gov
22. Acetabular superior wall fractures: a distinct acetabular fracture entity.pubmed.ncbi.nlm.nih.gov
23. Breaking the treatment dilemma of Schatzker IV fractures: finite element analysis validates hybrid single-plate with tension screw fixation for synergistic optimization of stability and minimally invasive outcomes.pubmed.ncbi.nlm.nih.gov
24. The role of hinged external fixation in the treatment of knee dislocation, subluxation and fracture-dislocation: A systematic review of indications.pubmed.ncbi.nlm.nih.gov
25. CT-like images based on T1-weighted gradient echo MRI sequences for the assessment of fractures of the hand and wrist compared to CT.pubmed.ncbi.nlm.nih.gov
26. Imaging of physeal injury: overuse.pubmed.ncbi.nlm.nih.gov
27. A Novel Physeal-Sparing Fixation Technique for Tibial Eminence Fractures in Paediatric Patients.pubmed.ncbi.nlm.nih.gov
28. Delayed Surgical Treatment of Pediatric and Adolescent Medial Meniscus Posterior Root Tears Is Associated With Increased Odds of Medial Tibiofemoral Compartment Cartilage Injury: A Multicenter Study.pubmed.ncbi.nlm.nih.gov
29. Concomitant Lateral Meniscal Tears in Pediatric and Adolescent Patients Undergoing Combined Medial Meniscal Ramp Lesion Repair and Anterior Cruciate Ligament Reconstruction Are Frequently Missed on MRI, Are Often Vertical or Root Tears, and Are Usually Repaired: A Multicenter Study.pubmed.ncbi.nlm.nih.gov
30. Suture Fixation Versus Screw Fixation in Pediatric Tibial Eminence Fractures: A Systematic Review and Meta-Analysis of Clinical Outcomes and Reoperation Rates.pubmed.ncbi.nlm.nih.gov
31. Morphological Evaluation of the Hip Joint and Pelvic Limb Bones of the Lowland Tapir (Tapirus terrestris Linnaeus, 1758) Using Radiography and Computed Tomography.pubmed.ncbi.nlm.nih.gov
32. Standardized MRI nomenclature for knee meniscal lesions: SSR consensus panel report.pubmed.ncbi.nlm.nih.gov
33. Revisiting meniscal anatomical variants of the knee: a high-resolution 7-Tesla MRI study.pubmed.ncbi.nlm.nih.gov
34. Management of type II tibial spine fractures in children and adolescents: a systematic review.pubmed.ncbi.nlm.nih.gov
35. Thinner Tibial Spine Fracture Fragments Are Associated With Risk of Fixation Failure.pubmed.ncbi.nlm.nih.gov
36. Avulsion injuries: an update on radiologic findings.pubmed.ncbi.nlm.nih.gov
37. Total laparoscopic radical hysterectomy for cervical cancer in prolapsed uterus.pubmed.ncbi.nlm.nih.gov
38. Arthroscopically assisted refixation of bony ACL tears with accompanying posteraleral tibial plateau ("apple bite") fractures - a minimally invasive treatment approach.pubmed.ncbi.nlm.nih.gov
39. Long-term outcomes of dual locking-plate fixation for bicondylar tibial plateau fractures via two mini-incisions: A prospective study.pubmed.ncbi.nlm.nih.gov
40. Pediatric knee avulsion fractures: A systematic review of injury patterns, treatment strategies, and outcomes.pubmed.ncbi.nlm.nih.gov
41. Tibial Anterior Cruciate Ligament Avulsion Fractures in Pediatric and Adult Populations: A Systematic Literature Review.pubmed.ncbi.nlm.nih.gov
42. Clinical and MRI Restoration of ACL Continuity Following Functional Complete ACL Rupture in an Adolescent Athlete: A Case Report.pubmed.ncbi.nlm.nih.gov
43. Congenital Anomalies of the Knee-Hypoplasia of the Meniscus: A Case Report.pubmed.ncbi.nlm.nih.gov
44. The Unique Features of Pediatric Sports Injuries: The Hip.pubmed.ncbi.nlm.nih.gov
45. The arrow and the target-description of the "Robin Hood" technique for fixation of tibial spine avulsion fractures: a technical note.pubmed.ncbi.nlm.nih.gov
46. Clinical outcomes following open reduction and internal fixation without primary cruciate ligament reconstruction or avulsion fixation for Schatzker types IV-VI tibial plateau fractures: a retrospective cohort study.pubmed.ncbi.nlm.nih.gov
47. A study on the association between tibial plateau fractures and intra-articular soft-tissue injuries under valgus injury mechanisms.pubmed.ncbi.nlm.nih.gov
48. Arthroscopic Treatment of Combined Anterior and Posterior Cruciate Ligament Avulsion Fracture: A Case Report.pubmed.ncbi.nlm.nih.gov
49. Results of Anterior Cruciate Ligament Avulsion Fracture by Treatment Using Bioabsorbable Nails in Children and Adolescents.pubmed.ncbi.nlm.nih.gov
50. A new CT-based classification system for posterior cruciate ligament tibial avulsion fractures: a nationwide multicenter study.pubmed.ncbi.nlm.nih.gov
51. Imaging of pediatric musculoskeletal trauma: Age-specific considerations and challenges.pubmed.ncbi.nlm.nih.gov
52. Fracture morphological characteristics and associated soft-tissue injuries in flexion varus tibial plateau fractures.pubmed.ncbi.nlm.nih.gov
53. A novel 3DCT-based classification for posterior cruciate ligament tibial avulsion fractures.pubmed.ncbi.nlm.nih.gov
54. A rare traumatic triad: Open bicondylar non-conjoint Hoffa fracture with partial tibial tubercle and medial epicondyle avulsions - A case report and biomechanical analysis.pubmed.ncbi.nlm.nih.gov
55. Modified Multi-Strand Nice Knot Suture Construct Combined with Suture Anchor Fixation Versus Conventional Kirschner Wire Tension Band Fixation for Inferior Patellar Pole Fractures: A Retrospective Comparative Study.pubmed.ncbi.nlm.nih.gov
56. Transcatheter arterial embolization for traumatic adrenal hemorrhage with contrast extravasation: case series and literature review.pubmed.ncbi.nlm.nih.gov
57. Pediatric ACL Injuries: A Current Concepts Review.pubmed.ncbi.nlm.nih.gov
58. Transosseous suture <i>in situ</i> repair treatment of a femoral anterior cruciate ligament avulsion fracture in a 30-year-old male patient: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
59. Guide to lower extremity radiologic measurements: part 1 hip.pubmed.ncbi.nlm.nih.gov
60. The Clinical Significance of Femoral and Tibial Anatomy for Anterior Cruciate Ligament Injury and Reconstructionpubmed.ncbi.nlm.nih.gov
61. No differences in knee anthropometric-related risk factors between unilateral and bilateral ACL reconstruction: A matched MRI-based cohort study.pubmed.ncbi.nlm.nih.gov
62. Heterotopic Ossification After Multiligament Knee Injury Is Associated With Knee-Spanning External Fixation and Central Nervous System Trauma.pubmed.ncbi.nlm.nih.gov
63. Schatzker IV tibial plateau fractures: are they always unicondylar?pubmed.ncbi.nlm.nih.gov
64. Proximal patellar tendon injury with avulsed periosteal sleeve: A case report and long-term follow-up.pubmed.ncbi.nlm.nih.gov
65. Patellar Non-Traumatic Pathologies: A Pictorial Review of Radiologic Findings.pubmed.ncbi.nlm.nih.gov
66. Magnetic Resonance Imaging Patterns of Common Injuries in Pediatric and Adolescent Athletes.pubmed.ncbi.nlm.nih.gov
67. The state of trial registrations in the field of Orthopaedics in years 2015-2020. A meta-epidemiological study.pubmed.ncbi.nlm.nih.gov
68. MRI-based classification of lateral hinge fractures in medial opening wedge high tibial osteotomy.pubmed.ncbi.nlm.nih.gov
69. Arthroscopic reduction of adult comminuted tibial eminence avulsion with single tunnel pull-through suture fixation: A case report of technical note.pubmed.ncbi.nlm.nih.gov
70. Gadolinium Deposition in Bone Tissues After Contrast-enhanced Magnetic Resonance Imaging: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
71. Ultrasound imaging of bone fractures.pubmed.ncbi.nlm.nih.gov
72. Longitudinal 3T MRI T 2 * mapping of Juvenile osteochondritis dissecans (JOCD) lesions differentiates operative from non-operative patients-Pilot study.pubmed.ncbi.nlm.nih.gov
73. Synthetic CT in Musculoskeletal Disorders: A Systematic Review.pubmed.ncbi.nlm.nih.gov
74. Does the mini-open technique still have a role in the modern management of pediatric tibial eminence fractures?pubmed.ncbi.nlm.nih.gov
75. Biomechanical comparison of a novel hockey-stick locking plate with a pes anserinus sparing design for Schatzker IV tibial plateau fractures.pubmed.ncbi.nlm.nih.gov
76. Osteotomies: Indications, Imaging Appearance, Surgical Techniques, and Complications.pubmed.ncbi.nlm.nih.gov
77. Innovations in pediatric imaging: a scoping review of the past decade with case illustrations.pubmed.ncbi.nlm.nih.gov
78. Smoking and lateral hinge fracture are associated with delayed union at 6 months in open wedge distal tibial tuberosity osteotomy.pubmed.ncbi.nlm.nih.gov
79. Three-dimensional meniscus allograft sizing-a study of 280 healthy menisci.pubmed.ncbi.nlm.nih.gov
80. Anatomical Knee Variants in Discoid Lateral Meniscal Tears.pubmed.ncbi.nlm.nih.gov
81. Radiographic Anatomy of the Native Anterior Cruciate Ligament: a Systematic Review.pubmed.ncbi.nlm.nih.gov
82. Current Landscape of Short-T2 Imaging Techniques in the Musculoskeletal System: The Past, Present and Future.pubmed.ncbi.nlm.nih.gov
83. Advanced Imaging of the Peripheral Nerves, From the <i>AJR</i> "How We Do It" Special Series.pubmed.ncbi.nlm.nih.gov
84. Conservative Treatment of Pediatric Fractures-Narrative Review of Acceptable Deformity and Remodeling Potential.pubmed.ncbi.nlm.nih.gov
85. Multiligament-injured knee: what the general orthopedic surgeon should know.pubmed.ncbi.nlm.nih.gov
86. A Modified Triangular Arthroscopic Suture-Based Fixation for Tibial Eminence Fractures: Technique, Outcome and Literature Review.pubmed.ncbi.nlm.nih.gov
87. Open wedge osteotomy of medial tibial condyle gives good results in management of neglected diagonal lesions of proximal tibia.pubmed.ncbi.nlm.nih.gov
88. From simulation to sideline: translating finite element modeling into clinical decision-making for pediatric ACL injury and rehabilitation.pubmed.ncbi.nlm.nih.gov
89. Surgical Treatment of Tibial Tubercle Fractures in Osteogenesis Imperfecta: A Restrospective Case Series.pubmed.ncbi.nlm.nih.gov
90. Bilateral Simultaneous Patellar Tendon Rupture in an Adolescent Athlete: A Case Report and Literature Review Highlighting the Role of Vitamin D Deficiency.pubmed.ncbi.nlm.nih.gov
91. Pull-out technique with footprint rivet repair of femoral-sided avulsion fracture of the anterior cruciate ligament: A case report.pubmed.ncbi.nlm.nih.gov
92. A Rare Post-traumatic Tibial Tubercle Avulsion Combined With a Complete Section of the Patellar Tendon in a Young Patient: Insight Into Surgical Management.pubmed.ncbi.nlm.nih.gov
93. UPDATES ON THE TREATMENT OF ANTERIOR TIBIAL TUBEROSITY AVULSION FRACTURES IN ADOLESCENTS.pubmed.ncbi.nlm.nih.gov
94. Long-term outcomes of arthroscopic single-anchor fixation versus microfracture for osteochondral fractures of the knee weight-bearing area in adolescents and young adults.pubmed.ncbi.nlm.nih.gov
95. Management and Outcomes of Osteochondritis Dissecans of the Knee in the Pediatric and Adolescent Population.pubmed.ncbi.nlm.nih.gov
96. Effectiveness analysis of arthroscopy-assisted medial retinaculum tightening suture with internal fixation for treating adolescent acute patellar dislocation with osteochondral fracture: A retrospective study.pubmed.ncbi.nlm.nih.gov
97. The role of ultrasound as a problem-solving tool in the assessment of paediatric musculoskeletal injuries.pubmed.ncbi.nlm.nih.gov
98. Atypically Displaced Meniscal Tears: An Educational Review with Focus on MRI and Arthroscopy.pubmed.ncbi.nlm.nih.gov
99. Glossary of terms for musculoskeletal radiology.pubmed.ncbi.nlm.nih.gov
100. Time-Sensitive Injuries for the Sports Medicine Surgeon - "Sports Medicine Trauma", Part 2: Lower Extremity.pubmed.ncbi.nlm.nih.gov
101. Treatment of anterior cruciate ligament injury in skeletally immature patients.pubmed.ncbi.nlm.nih.gov
102. Tibial plateau fractures are associated with ligamentous and meniscal injuries. Preoperative evaluation of magnetic resonance imaging influences surgical treatment.pubmed.ncbi.nlm.nih.gov
103. Exploring the Posterolateral Corner of the Knee Joint: A Detailed Review of Recent Literature.pubmed.ncbi.nlm.nih.gov
104. A Systematic Approach to the Evaluation of Acute Musculoskeletal Injuries in the Emergency Department.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.