Tibial spine avulsion fractures are predominantly paediatric fractures that are rarely encountered in adults. These fractures are increasing in incidence and can adversely affect knee stability and mobility if not treated swiftly and appropriately.

Material and methods. We report an unusual case of a tibial spine avulsion in a 68-year-old female and believe this to be the oldest in literature.

Results. This is a highly unusual fracture to be seen in this age demographic. Adults presenting with tibial avulsions often have associated injuries and morbidities.

Conclusion. Optimising prognosis requires an early and accurate diagnosis to guide the appropriate, and often surgical, treatment.