Open reduction and internal fixation of the tibial avulsion fracture of the posterior cruciate ligament: which is better, a hollow lag screw combined with a gasket or a homemade hook plate?

Abstract

Objective To compare the clinical results of homemade hook plates and hollow lag screws combined with spacers in the treatment of posterior cruciate tibial ligament avulsion fractures. Materials and methods This was a retrospective clinical cohort study that included 64 patients with PCL tibial avulsion fractures. Thirty-two of them were fixed with a homemade hook plate (hook plate group), and 32 were fixed with a hollow lag screen combined with a gasket (hollow lag screen group). By reviewing the medical record data and follow-up results, the operation time, postoperative drainage, fracture healing time, surgical complications, knee mobility, recovery of joint function, and whether postoperative gastrocnemius muscle strength changed in the two groups were compared. Results All patients had successful wound and fracture healing. No adverse events, such as bone nonunion, infection, wound haematoma, or joint stiffness, occurred in either group. There were no patients with decreased gastrocnemius muscle strength in either group. Internal fixation failure occurred in 2 cases in the hollow lag screen group but not in the hook plate group. There were no significant differences between the two groups in terms of operative time, postoperative drainage, fracture healing time, knee mobility at the last follow-up, or Lysholm score. Conclusion It is safe and effective to use a homemade hook plate to fix PCL tibial avulsion fractures through an inverted L-shaped posterior medial approach. A homemade hook plate may have potential advantages over a hollow lag screen combined with gasket fixation.

Homemade pin-hook for surgical treatment of posterior cruciate ligament avulsion fractures

“…In addition, this helped prevent re-embedding of the surrounding soft tissue into the fracture site during reduction and decreased the likelihood of fracture nonunion. Debate still exists regarding the technique for fixation [17,18]. Perfect fixation should have the advantages of easy operation, reliable reduction and appropriateness for popularization.…”

Stepping into the Unknown: Unveiling the Rarity of PCL Fracture-Avulsions

“…Nevertheless, it is essential to note that access to these methods may be limited in some medical facilities that have not yet fully mastered or adopted arthroscopic technology. Consequently, open reduction and internal fixation remain the preferred surgical option for some patients due to the challenges of learning and mastering arthroscopic techniques [ 7 ].…”

Biomechanical study of posterior cruciate ligament tibial arrest avulsion fracture fixation with triple tibial channel net sutures

“…Trickey et al 3 reported for the first time the treatment of PCL tibial avulsion fractures with open reduction and cancellous bone screw fixation. Screw fixation has shown good clinical results 4 – 6 ; however, screw fixation requires a second operation to remove the implant and is not suitable for small fracture blocks. Arthroscopic suture fixation of tibial avulsion fractures can overcome the shortcomings of the above fixation methods and is currently a generally accepted treatment method 7 , 8 .…”