Medial Tibial Epiphysis

The distal tibial epiphysis ossifies between 6 and 24 months of age. The medial malleolus appears at 7-8 years and is complete at 10 years. It usually ossifies as a downward extension of the distal tibial ossific nucleus but may develop as a separate centre of ossification and thus be mistaken for a fracture line. The distal tibial physis closes first centrally, then medially and finally anterolaterally (Fig. 15.1), with the entire process lasting about 18 months. This sequence of closure of the distal tibial physis is important in the pattern of transitional fractures (triplane and juvenile Tillaux). Completion of distal tibial physeal closure is at around 14 years in girls and 16 years in boys. 

Fig. 14.28). Somewhat similar to the situation with the supraspinatus tendon, the examiner should be aware that the actual site of insertion is indicated by the prominence of the tuberosity and not by the anterior aspect of the tibial epiphysis. Short-axis US images of the patellar tendon are essential because the involvement by tendinopathy may occur out of the midline and possibly limited to the external borders of the tendon (Fig. 14.30). These planes depict a flattened tendon, shaped like a rectangle. In addition, they allow assessment of the medial and lateral patellar retinacula as sheet-like fibrous expansions attached on each side of the tendon (Fig. 14.30). Calcifications and ossification of the distal portion of the tendon can be encountered in asymptomatic subjects and are usually related to consequences of Osgood-Schlatter disease. 

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