Combined physeal/apophyseal fracture of the proximal tibia with anterior angulation from an indirect force: report of 2 cases.

Physeal fracture of the proximal tibia is a rare injury, comprising less than 2% all physeal injuries. The literature distinguishes between tibial tubercle avulsions (apophyseal injuries) classified by Ogden, Tross, and Murphy as type I, II, and III and Salter-Harris II fractures. An extensive review of the literature located only 5 cases in which patients sustained a combined fracture of the proximal tibial physis and tibial tubercle. We report 2 such cases, which are not amenable to classification by current systems, and agree with Ryu and Debenham's suggestion to add a fourth type, avulsion hinge fracture of the proximal tibial eplphysis, to the Watson-Jones/Ogden classification.