High-speed electric-scooter crash causing a tibial spine fracture with physeal extension in an adolescent: a case report

Tibial spine fractures are pediatric anterior cruciate ligament-equivalent avulsion injuries that can be radiographically subtle, leading to delayed or missed diagnosis. We report the case of a healthy 14-year-old girl who sustained a high-speed electric-scooter crash, landing on both knees in flexion. Initial radiographs obtained at a community hospital were interpreted as normal despite persistent pain, swelling, and complete functional impairment of the right lower limb. On re-evaluation, comparative anteroposterior and lateral radiographs revealed subtle elevation of the right tibial intercondylar eminence, and computed tomography confirmed a tibial spine avulsion with a Meyers-McKeever type II pattern, extending into the proximal tibial physis and associated with a nondisplaced tibial plateau fracture. The patient was treated nonoperatively with gentle closed reduction under sedation followed by six weeks of immobilization in a long-leg plaster cast in slight flexion. Post-reduction imaging showed anatomic alignment of the tibial spine fragment and maintained plateau congruity. At six weeks, radiographs documented union without secondary displacement, and by eight weeks she had symmetric range of motion and a stable Lachman test, with no pain or instability. This case report highlights the need for repeat and cross-sectional imaging when clinical suspicion persists and illustrates that carefully selected type II tibial spine fractures with associated injuries may be successfully managed without surgery.