The purpose of this study was to report the long-term clinical outcome in a group of 14 patients treated for an avulsion fracture of the tibial spine. On the basis of the Meyers and McKeever classification, there were four type I avulsions, three type II and seven type III. Seven patients were treated nonoperatively and seven patients were operated according to one of the two different protocols: open reduction and internal fixation and arthroscopic reduction and internal fixation. At follow-up, four patients had clinical signs of joint instability, but no subjective instability. One patient with a type III lesion treated nonsurgically showed severe instability. All other patients returned to the same sport activity level that they had had before the fracture. We obtained good results in 13 out of 14 cases. Good results can be obtained when type I fractures are treated nonoperatively. Type II and type III lesions showed better results after arthroscopic reduction and internal fixation. Nonabsorbable suture fixation for osteosynthesis is recommended. The prognosis is strictly related to the type of fracture, anatomic reduction and articular congruity.

Subscapularis injury in adolescents, usually associated to an avulsion fracture of the lesser humeral tuberosity, accounts for less than 2% of all fractures of the proximal humerus. Isolated tears of the subscapularis tendon without a history of dislocation and associated avulsion fractures are an even rarer occurrence, and treatment is controversial. This article describes a rare case of a 12-year-old suffering from an isolated subscapularis tear and discusses its management. The patient was evaluated at presentation, and at 1 to 2.5 months after he underwent a cuff tear arthroscopic repair with a single “all suture” anchor loaded with two wires, active/passive range of motion (A/PROM), Constant–Murley score, and American Shoulder and Elbow Surgeons (ASES) score were noted. Patient reported an excellent outcome, recovered the whole ROM, was pain free, and returned to the previous level of activity. Isolated avulsion of the subscapularis tendon requires a high index of suspicion for a proper diagnosis as early treatment is required for a good recovery. Arthroscopy reserves more advantages in proper hands, restoring the previous levels of function and activity. An increase in attention for this condition is mandatory in a society where many adolescents are getting more and more active in high levels of sport activities.

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