Management and outcomes of isolated paediatric tibial spine fractures

Paediatric fractures of the tibial spine are relatively rare and controversy remains around how these injuries are best managed (Gans et al., 2014; Hargrove et al., 2004). Consequently most non-specialised paediatric units have limited experience of managing these injuries. This study aims to review the management and outcomes of isolated paediatric tibial spine fractures in a tertiary paediatric orthopaedic centre between 2008 and 2016. Data were collected on patient demographics, mechanism of injury, imaging, Meyers and McKeever grade of injury (Meyers and McKeever), management and outcomes, including Cincinnati and Lysholm-Tegner knee scores at a mean of 36 months post-operatively. 40 patients were included, 21 were male and the mean age was 11.8 years. 3 cases were Meyers and McKeever type I, 13 were type II and 24 were type III. 30 underwent operative management comprising of open reduction and single screw fixation, with or without a washer. 9 patients underwent subsequent metalwork removal at a mean of 10 months post-operatively. 10 underwent non-operative management, consisting of cast immobilisation and bracing. 33 patients (83%) were available for follow up. No statistically significant differences were seen in either outcome score between those treated operatively or non-operatively, or between different grades of injury, or if metalwork were removed or not. Our study shows good functional outcomes following paediatric tibial spine fracture. We advocate the use of CT to assess fracture displacement to help guide management. We have shown type I and reducible type II injuries can successfully be managed conservatively and non-reducible type II and type III injuries can be successfully treated with open reduction and single screw fixation. In our experience post-operative knee stiffness can persist for up to 6 months but generally improves. Metalwork removal was only indicated if the patient had on going stiffness after this time or if they had on going pain.