avulsion fracture of the tibial tubercle?

[Sunny01]

Would you be content with the following X-Ray image being explained as a "sprain behind the kneecap"?

 

My 11 year old son wrapped his leg around the extention of a zip line at the local park a few days ago, then used that foot to hold on to a bar behind him before raising his right leg and enjoying the ride down.

 

He cannot straighten or bend the knee without pain and the affected kneecap is higher than the other. Following an X-Ray at A&E the Doctor sent us to the fracture clinic.

 

At the clinic the consultant told us it was a sprain behind the kneecap which will heal in 2 to 3 weeks.

 

When I pointed out what I thought looked like fracture he said that if this xray was from an adult, he would say it is fractured, but an 11 year old bone growth can present like this. Who am I to argue? If anyone understands how this possible please enlighten me.

 

Looking at X-Rays online, the condition in the title is what resembles my sons X-Ray the most. And learning that late treatment in children will cause issues with bone growth later on down the road. which is very worrying.

 

Thank You for reading this far, any opinions will be most welcome

 

[45002]

Make a appointment ASAP to see child GP and let them sort it out and not Dr Google.

 

You may need to see a paediatric orthopaedic consultant for advice, a GP can refer the child if necessary.

Edited August 12, 2020 by 45002

[Sunny01]

The paediatric orthopaedic consultant at the fracture clinic told us today that he believes it is just a sprain behind the knee.

I'm concerned my GP will say something along the lines of, 'you have seen a consultant, he says it will heal in 2 to 3 weeks, you don't know more than him!', or something like that.

 

It's just that I believe I can clearly see a fracture.

And as there was no fall or hard knock, only a very tightly stretched knee bending at an angle behind, with a load.

I figured that the tendon must have pulled some bone up. And thats the injury I found online.

 

I totally take on board what you are saying.

You are correct.

I guess I'll see what my GP says tomorrow, hopefully she allows me to email the images, if she doesn't have access to them already. Thanks again

[Manxman in exile]

Can you ask your GP to get a second opinion on the NHS?  (I ought to know because I'm a retired NHS manager, but worked in mental health where x-rays didn't really feature very much(!).)

 

Your GP may be reluctant for various reasons but you've got nothing to lose by asking.  Might be difficult if there's only one consultant in that specialty locally.

 

If that is a non-starter, you could ask your GP for a private referral if any of the relevant specialists run private clinics.  Your son'll get seen quicker and an initial private consultation shouldn't cost more than about a couple of hundred quid.  Then take it from there.

 

(Emphasise to your GP what your real concerns are and why you have them - even if it's just "I looked it up on the internet and it looks like this which can lead to serious complications.  What do you think?  I'm really worried...")

 

EDIT:  Just looked on my local NHS Clinical Commissioning Group website and searched for "second opinion" but nothing comes up...  I thought you were entitled to one - you'll have to ask your GP.  Or look on your own CCG site.  Oh - despite being a NHS manager I have paid to see a consultant privately.  £150 well spent - if you can afford it... which I appreciate not everyone can.

Edited August 12, 2020 by Manxman in exile

[dx100uk]

sprained tendon will do exactly as you said.

sadly i had the same injury that took me out of running for four months .

kneecap was high too really looked weird!

[Sunny01]

Thank you for the replies. I really hope the consultant at the fracture clinic was correct, that it is a sprain and full motion will return within 2 to 3 weeks.

G.P telephone consultation is also booked now

Looking at the image, I see bone lifted off the main bone, or maybe not, hopefully not. Cheers

 

[Sunny01]

Looking at the xray above amd my sons continues pain, we went to another A&E to seek a 2nd opinion. The gentlemen at the fracture clinic at Guys arranged an MRI which does show a fracture. So we are returning to the original fracture clinic for some treatment hopefully. I think the least his knee should be imobilised a cast right? Thank you

[Manxman in exile]

Well done.

 

If your son has been in unnecessary pain as a result of the original mis-diagnosis from the fracture clinic, I personally would be thinking about complaining formally or at least drawing the original error to the attention of hospital management.  It may very well be a simple error but the original diagnosis seems like it may have been unjustifiably definite in its certainty, meaning that you might be less inclined to seek further advice when you should do, thus increasing the risk of further damage.  (After all, you're no expert but you had doubts about the diagnosis and asked what people here thought).

 

People who know I'm a retired NHS manager are sometimes surprised when I say "Make a formal complaint", but if people don't make complaints when they should, these sort of mistakes never get corrected.

 

(Incidentally, did you just turn up at Guy's or did you go to your GP asking for a second opinion?)

[Sunny01]

Thank you Manxman.

 

So I'm just back from the consultation at the fracture clinic of my local Hospital. My son recieved a harder brace (which he must take off at night) and told "there is no fracture, the problem is radiologists see scans but do not examine the patient so misdiagnose, I will order the MRI images from Guy's and see you in 2 weeks. he has osgood schlatter disease".

 

I have never heard of that disease until today so am reading about it now. My son is not convinced, but I, so far, hope the Dr is correct as this condition apparently never returns after the age of 14 and requires no surgery.

 

I was originaly waiting for a G.P appointment but my son is in so much we decided to take him to a different A&E. For some reason that just feels wrong but what do I do when my son is holding a picture of his x-ray saying, dad, that is not a sprain, I am in agony etc.  Thanks for your replies and I appreciate any thoughts

[Manxman in exile]

OK.  I suppose it's still interesting that the original diagnosis was at least to some extent mistaken.  (Although I have heard of Osgood-Schlatter's - a school friend of mine had it - I understand it can be difficult* to diagnose.)

 

Good luck to you and your son.

 

*Even though I worked in the NHS for 25 years I sometimes forget that some conditions are just difficult to identify - even for experts.

[Sunny01]

Thank you. I still believe that a fracture exists as detailed on the MRI report, as there has been no history with any pain of his joints and this a result of an injury sustained in the park when he extensively flexing his L knee with a load. But the Dr said that as he can lift his leg (in pain), no fracture exists. I don't know

[Sunny01]

So just back from the fracture clinic where we were seen by a different doctor with the MRI images.

This Doctor however agreed with the report generated by Guy's, and pointed out where the fracture is seen on the the MRI. There was no mention of Osgood Schlatter desease, but said that as no bone has lifted there is no need for surgery. He was seen by physio and reassured that the excessive swelling is normal even after 8 weeks.

I have everythig crossed that he will make a full recovery with the help of physiotherapy

Edited September 17, 2020 by Sunny01
spelling

[Manxman in exile]

Hope it mends well.  Good luck to your son.