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Case: A 46-year-old man sustained a direct anterior impact to the proximal tibia by a sharp weapon. The associated wound was superficial at the impact site, but the injury was classified as a Gustilo-Anderson type II open fracture. Radiographs suggested an extra-articular tibial tubercle avulsion-type fragment, and CT was not obtained. After initial irrigation and debridement, staged definitive fixation was performed one day later. Intraoperatively, the fracture was found to be a continuous anterior osteoarticular fragment extending from the anterior tibial plateau to the tibial tubercle, including the patellar tendon insertion. Because the patellar tendon prevented safe plate placement, fixation was achieved with three 4.5-mm partially threaded screws and washers. At 2-month follow-up, the patient had full knee range of motion and a Lysholm Knee Score of 86.
Conclusion: This rare adult anterior tibial plateau fracture variant may mimic a tibial tubercle avulsion injury on radiographs. CT should be considered for fractures near the joint line to avoid underestimation of intra-articular extension and to improve operative planning.

Keywords: Tibial plateau fracture; Anterior tibial plateau; Tibial tubercle; Open fracture; Screw fixation; Case report