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[Fractures of the tuberculum intercondyloideum laterale in children]
Insights
Surgical fixation of tibial spine fractures in children yields excellent results, particularly for displaced or unstable fractures. Conservative treatment is suitable for non-displaced fractures without instability, with immobilization under 30 days for all cases.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Sports medicine
Background:
- Tibial spine fractures, involving the anterior cruciate ligament attachment, are significant injuries in pediatric patients.
- Understanding the mechanisms and appropriate treatment is crucial for optimal outcomes.
Purpose of the Study:
- To review outcomes of surgically and conservatively treated tibial spine fractures in children.
- To define treatment indications based on fracture displacement and knee stability.
Main Methods:
- Retrospective review of 31 pediatric tibial spine fractures (2 old), treated conservatively (10) or operatively (21).
- Follow-up ranged from 6 months to 7 years.
- Assessment included clinical examination (anterior drawer test) and stability testing under general anesthesia.
Main Results:
- Twenty-seven cases were available for study.
- Excellent results were achieved in 23 cases, good in 3, and poor in 1.
- Surgical fixation through a tibial tunnel was indicated for displaced/unstable fractures; conservative for non-displaced/stable fractures.
- Immobilization did not exceed 30 days for any treatment group.
Conclusions:
- Surgical treatment for displaced or unstable tibial spine fractures in children provides excellent outcomes.
- Conservative management is appropriate for stable, non-displaced fractures.
- Appropriate management and limited immobilization are key to successful pediatric tibial spine fracture treatment.
Abstract:
Thirty-one fractures of the tibial spine in children have been treated, two of them being old fractures. They were reviewed after a minimum follow-up of six months and a maximum of seven years. Ten were treated conservatively, 21 operatively. The mechanism is discussed. The trauma is described as either a posterior displacement of the femoral condyle or rotation and abduction of the leg with the knee flexed. The importance of testing stability under general anaesthesia is stressed. Sixteen cases had an anterior drawer sign. The medical meniscus was only injured in one case. The indications for treatment are: Conservative treatment should be given in fractures without displacement and without instability. All other types should be treated surgically with fixation of the anterior cruciate ligament made through a tunnel in the tibia. Whichever type of treatment is used, the length of immobilisation in plaster should not exceed 30 days. Twenty-seven cases were available for study. Twenty-three had excellent results, three good results and one poor result.