A 14 year-old boy fell on the ground while landing from a high jump during a basketball game. He felt immediate bilateral knee pain and was unable to stand. The physical examination, performed in the Emergency Room of our Hospital, showed bilateral anterior knee swelling, with a marked restriction of the range of motion of both knees. No neurovascular deficits were present. The patient was a well-developed teen-ager, who weighed 80 kg and was 180 cm tall; no previous history of trauma was reported. Antero-posterior and lateral radiographic examinations of both knees showed bilateral fractures of the proximal tibial physis, classified as flexion-type Salter-Harris II, non-displaced on the right side and displaced on the left with an anterior apex.
The day after admission to our Hospital, the patient was treated in the operating room under general anaesthesia. The displaced fracture was reduced, under fluoroscopic control, by closed manipulation in hyperextension but, since it was unstable, it was fixed percutaneously by two 5 mm cannulated screws, introduced from the anterior tibial tubercle to the posterior metaphyseal cortex. A long-leg cast extending above the knee was applied in extension position. The same cast was applied to stabilize the non-displaced fracture, without any fixation. Both casts were left in place for six weeks without weight-bearing. X-rays of both knees, performed one week after the operation, did not show any secondary displacement of the fractures. Six weeks after surgery the casts were removed, and x-rays showed complete healing of both fractures. The patient started physical therapy and weight-bearing was allowed. At the final follow-up, one year after the operation, the patient had resumed playing basketball without restrictions, the range of motion of both knees was complete, and no deformity or leg-length discrepancy was present. The radiographic examination showed almost complete fusion of the proximal tibial epiphyses of both knees (Fig. 1).