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Clinical presentation:
13 year old boy with pain his right knee.

The right tibial tuberosity is fragmented and its adjacent soft tissues are ill-defined, including the patellar ligament. There is no joint effusion and bone density is preserved.

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[Differential]

cases that might resemble this pathology

[View large image] Avulsion fracture. (case report) [View large image] Scleroderma. (case report)
[View large image] [View large image]
Tuberculosis (case report) include other causes of septic arthritis and juvenile rheumatoid. [View large image] Gout (case report) no large joint example.
[View large image] Charcot joint, Spina-bifida. (case report) [View large image] Osteochondromatosis (case report). is probably excluded by the young age of the patient, but consider pigmented villo-nodular synovitis.
[View large image] Finally.. In an adolescent with pain around the knee, never ignore the possibility of Osteosarcoma (case report). Include other primary malignant bone tumours.
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[London South Bank U.]

IDM May 2007