Avulsion fractures of tibial intercondylar eminence is a rare injury mainly affecting the pediatric population between 8 to 14 and is even rarer in adults with very few cases reported in literature. It occurs with high energy trauma in adults and may be associated with knee dislocation and neurovascular injuries. A 30 yr old male presented with a painful swollen left knee, limited knee motion, and difficulty with weight bearing after a history of fall from motorcycle. Imaging revealed Type 3 Meyers and McKeever tibial spine avulsion of both ACL and PCL. A two staged surgical procedure was performed: (a) Arthroscopic reduction and fixation with headed cannulated screw of ACL tibial fragment; (b) ORIF with headed cannulated screw of PCL tibial fragment via posterior approach to knee. Good functional outcome and early mobilization was achieved. Diagnostic arthroscopic helps to evaluate the condition of the cruciate ligaments as well as fracture bed. Simultaneously fixation of ACL fragment with cannulated screw can be done, which is a simpler procedure to suture fixation. ORIF of PCL fragment in a staged manner has helped to address the injury in a detailed manner achieving goal of anatomical reduction and early mobilization.

BACKGROUNDThe midshaft clavicle fractures account for 3 to 5% of all injuries and 70 to 80% of all clavicle fractures in young adults; these fractures are usually related to sports or vehicle accidents, whereas in children and elderly they are usually related to falls. In general, clavicle fractures are treated conservatively and have a good outcome. In 1960, Neer reported a non-union rate of 0.1% with conservative treatment and Rowe corroborated these findings in 1968 and showed a non-union rate of 0.8% in conservatively managed patients. Since then, however, other authors have failed to demonstrate similar good results with conservative treatment. More recently, there has been a trend toward surgical fixation. Surgery has been indicated for completely displaced fractures, potential skin perforation, shortening of clavicle by more than 20 mm, neurovascular injury and floating injury. The gold standard for the surgical treatment has been open reduction and plate fixation through a large incision. Other surgical options include intramedullary pinning with Kirschner wire, Rush pins, Knolwes pin, Steinman pin, Haige pin, ESIN (Elastic Stable Intramedullary Nailing) and external fixation.