Working Diagnosis:
Acute Compartment Syndrome secondary to unknown cause-fracture verses internal derangement knee.

Treatment:
: EMS was called and transported him to Pediatric Emergency Room. The Orthopedic Surgeon was awaiting his arrival; and, immediately, he was taken to the operating room. Anterior and lateral fasciotomies were performed 21 hours after the time of his initial left knee injury. His wounds were closed 72 hours later and he was discharged with the diagnosis Traumatic Compartment Syndrome left lower extremity.

Outcome:
He returned to outpatient orthopedic clinic one week later. Pain was improved and he was instructed to weight bear as tolerated with the assist of a walker. The following day he fell on the left knee and sustained a Type 3 displaced tibia tubercle avulsion fracture requiring open reduction and internal fixation. Case Photo #2

Return to Activity and Follow-Up: Return to activity all placed on hold as he is recovering from traumatic compartment syndrome secondary to a tibia tubercle avulsion fracture which subsequently displaced.

Author's Comments:
This case illustrates a missed Type 1 Avulsion fracture of the tibial tuberosity causing subsequent preoperative acute compartment syndrome.

Tibial tubercle fractures represent high-energy injuries with potentially devastating complications such as preoperative compartment syndrome and/or vascular compromise.

It is important for clinicians to recognize that compartment syndrome remains a significant concern post-injury and in the perioperative period (1).

A simple treatment algorithm using modified Ogden Classification can help manage these injuries (1).

Intra-articular involvement is often missed with the use of plain x-ray and drastically underestimates injury severity. The use of preoperative CT scan or MRI should be utilized as adjunct to plain lateral radiograph (2)

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