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SCREW VS. SUTURE FIXATION FOR TIBIAL EMINENCE FRACTURES: A META-ANALYSIS
Paulo Eduardo Dias Lavigne1, Marcus Vinicius Ribeiro1, Victor Mendes Ribeiro1
1Universidade Federal de Sao Paulo (EPM/UNIFESP), Escola Paulista de Medicina, Sao Paulo, SP, Brazil.
Insights
Screw versus suture fixation for pediatric tibial spine fractures show similar functional outcomes. Screw fixation offers shorter surgery but increases reoperation and implant removal risks.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
Background:
- Tibial spine fractures are common in children.
- Fixation methods include screw and suture techniques.
Purpose of the Study:
- Compare functional and surgical outcomes of screw versus suture fixation in pediatric tibial spine fractures.
Main Methods:
- Systematic review following PRISMA guidelines.
- Included four retrospective cohort studies with 186 patients.
- Assessed postoperative knee function, operative time, reoperation, implant removal, joint instability, and return to sport.
Main Results:
- No significant difference in knee function (SMD = -0.07; p = 0.702).
- Screw fixation had shorter operative time (MD = -9.17 minutes; p < 0.001).
- Screw fixation showed higher reoperation (RR = 1.78; p = 0.040) and implant removal rates (RR = 6.25; p = 0.040).
- No differences in joint instability (RR = 0.90; p = 0.770) or return to sport (RR = 1.83; p = 0.190).
- Potential publication bias identified.
Conclusions:
- Both screw and suture fixation provide similar functional outcomes for pediatric tibial spine fractures.
- Screw fixation is associated with reduced operative time but increased complication risks.
- Level of evidence IIa; systematic review of cohort studies.
Objectives:
To compare functional and surgical outcomes between screw and suture fixation in pediatric tibial spine fractures.
Materials And Methods:
This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251022233). Cohort studies comparing arthroscopic screw versus suture fixation were included. The primary outcome assessed was postoperative knee function.
Results:
Four retrospective cohort studies were included, totaling 186 patients. No significant differences were found in knee function (SMD = -0.07; p = 0.702). Operative time was significantly shorter in the screw group (MD = -9.17 minutes; p < 0.001). However, this group showed a significantly higher risk of reoperation (RR = 1.78; p = 0.040) and implant removal (RR = 6.25; p = 0.040). No differences were observed regarding joint instability (RR = 0.90; p = 0.770) or return to sport (RR = 1.83; p = 0.190). Funnel plot analysis suggested potential publication bias.
Conclusion:
Both techniques yielded similar postoperative functional outcomes. Screw fixation was associated with shorter operative time but higher complication rates. Level of evidence IIa; systematic review of cohort studies.
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