An alternative to fixation of displaced fractures of the anterior intercondylar eminence in children

Abstract

Fractures of the anterior intercondylar eminence in children are relatively uncommon. There is considerable debate as to the best treatment of displaced fractures, but most methods described in the literature involve an open procedure combined with some form of fixation. Using human anatomical dissections, we have shown that the transverse meniscal ligament can become incarcerated within the fracture and act as a block to reduction. We describe an arthroscopic technique which requires no fixation device and report the results of its use in eight displaced fractures. This method gives reliable results and offers the advantage of less potential morbidity.

Tibial eminence fractures in the paediatric population: A systematic review

“…There was a varied method of reporting outcome, including clinical follow-up only, outcome scores and objective tests. The most common outcome scores were the International Knee Documentation Committee (IKDC), the Tegner Activity Score (TAS) and the Lysholm Knee Score (LKS) [ 1 , 5 , 6 , 9 , 10 , 14 – 16 , 20 , 21 , 23 , 27 , 30 , 32 , 35 ]. The most common objective test was the KT1000 for measuring knee laxity [ 1 , 6 , 7 , 9 , 15 , 21 , 22 , 24 , 26 – 28 , 32 , 35 ].…”

“…A number of smaller case series also reported interposition of menisci or the transverse ligament in the fractures site on arthroscopy [ 1 , 5 , 7 , 16 , 20 , 22 , 23 , 30 , 31 ]. In one case series, a non-union of a type III fracture treated in plaster was attributed to soft tissue interposition [ 5 ].…”

“…Several older studies have proposed that type II, III and IV fractures do not require fixation [ 3 , 11 , 23 , 24 ]. Table 4 outlines differences in management of these fractures patterns.…”

“…Arthroscopic anterior cruciate ligament guides have been popular in aiding in reduction and guiding fixation with arthroscopic techniques [ 1 , 7 , 14 , 26 , 30 ]. Some techniques include arthroscopic assisted surgery, and report little increased morbidity with a mini-arthrotomy [ 23 , 28 ].…”

Tibial Spine Fractures in Children: Evaluation, Management, and Future Directions

“…Straight-leg casts have been favored in small series based on the added physiologic reduction of the tibial spine fragment from contact with femoral condylar surface. 17,44 Evidence beyond these small studies is lacking, and to our knowledge no prospective study comparing flexion to straight-leg casting has been completed.…”