Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients

Abstract

Tibial eminence fractures most commonly occur in children and adolescents. When treating displaced fractures of the tibial eminence, some surgeons prefer screw fixation whereas others prefer suture fixation. The ultimate goal is to limit morbidity through early return to range of motion and activity. In this technical note, we describe 2 hybrid fixation techniques for fixing tibial eminence fractures, one for type III and the other for type IV fractures. The first technique (variation A) is used to treat type III fractures and combines use of both a bioabsorbable compression screw and suture for fixation. The second technique (variation B) is used to treat type IV fractures and combines use of both a bioabsorbable compression screw and shoulder anchor fixation. We have found that these methods provide efficient, secure, and reliable fixation using standard techniques common to arthroscopic surgery. In addition, the growth plates are spared in children and adolescents, and the need for reoperation to remove hardware is eliminated.

Arthroscopic Surgery in Children and Adolescent – A Domain to Be Developed

“…The slow progression of the rehabilitation pushed us to remove the implant three months after the surgery due to some skin discomfort in front of the titanium button. Arthrofibrosis is a known complication of the tibial spine fracture [12]. Early start of rehabilitation program may enhance the development of such complication.…”

Arthroscopic Fixation Of Tibial Spine Avulsion Fractures: Strangulation Technique

“…And it is necessary to preserve the native ACL as it has mechanoreceptors for proprioception and neuromuscular control [12]. Various methods have been described to fix this fracture which includes k-wire [13], cancellous screws [14], Herbert screws [15], staples [16], stainless steel wires [17], suture anchor [18], meniscal arrows [19], sutures [20][21][22][23][24] or combination [25] of these methods and mini-open or arthroscopic repair [26]. Suture fixation is relatively better than screw fixation.…”

A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture

“…Operative treatment included open reduction and internal fixation 9,10 ; however, arthroscopically assisted reduction and fixation have gained popularity and have been described with relatively high success rates. [11][12][13][14][15][16][17][18][19] Multiple arthroscopically techniques have been described to treat tibial eminence fractures, including cannulated metal screws, 5,20,21 Kirschner wires, 22 stainless steel wire, 15 sutures via transphyseal bone tunnels, 7 suture anchors, 11,23,24 bioabsorbable screws or nails, and hybrid constructs. 4,5,22 However, there is currently no standard gold treatment.…”