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Tibial eminence fractures in the paediatric population: a systematic review
Christy Coyle1, Simond Jagernauth, Manoj Ramachandran
1Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
Insights
This review highlights that while non-operative management is common for pediatric tibial eminence fractures, internal fixation is preferred for more severe types. Arthroscopic surgery shows better outcomes than open surgery, but more research is needed.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Sports Medicine
Background:
- Tibial eminence fractures are common in children.
- This systematic review examines injury types, treatments, and complications.
Purpose of the Study:
- To review the literature on managing tibial eminence fractures in pediatric patients.
- To assess injury modalities, treatment options, and associated complications.
Main Methods:
- A systematic review of 740 English-language citations was conducted.
- 36 full-text articles met the inclusion criteria for analysis.
Main Results:
- Common injuries include skiing, sports, and motor vehicle accidents.
- Non-operative management is recommended for type I fractures; fixation for types II and III.
- Arthroscopic surgery yields better long-term results than open surgery.
- Fixation methods lack consensus; complications include arthrofibrosis and laxity.
- Early range of motion exercises reduce arthrofibrosis.
Conclusions:
- Current evidence is based on small case series.
- Level I studies are needed for definitive management guidelines for pediatric tibial eminence fractures.
Introduction:
We present a systematic review of the literature for the management of tibial eminence fractures in the paediatric population. Our aims were to assess modalities of injury, treatment options available and their associated complications.
Materials And Methods:
We found 740 relevant citations in the English literature up to 1 October 2012, of which 36 full text articles met our inclusion criteria.
Results:
Our results show that skiing, sports and motor vehicle accidents are increasingly common modes of injury, in addition to the commonly described fall off of a bicycle. Most studies advocate non-operative management for type I Meyer's and McKeever's fractures and reduction and internal fixation for type II and III fractures. Better long-term results have been reported with arthroscopic surgery compared to open surgery. There is no consensus as to which type of fixation is best suited for tibial eminence fractures; methods available include excision of the bony fragment, K-wire, screw and, absorbable suture fixation, and more recently, suture anchor and meniscal arrow. The main complications reported include arthrofibrosis, non-union, mal-union, pain and severe laxity. Early post-operative range of motion exercises have been shown to reduce the incidence of arthrofibrosis.
Conclusion:
As all papers report results from small case series, Level I studies are required to produce more definitive evidence for the management of paediatric tibial eminence fractures.
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