Arthroscopic treatment of tibial spine fracture in children with a cannulated Herbert screw

Abstract

Background: Avulsion fractures of the anterior tibial intercondylar eminence in childhood are rare and are severe injuries of the knee. Since the injury is equivalent in aetiology with ruptures of the anterior cruciate ligament, the treatment requires anatomic reduction and preservation of the stability of the joint. The aim of the study was to demonstrate our experiences with the arthroscopy-guided Herbert-screw fixation in the treatment of displaced tibial eminence fractures in children.

Methods: Between January 2004 and December 2011, a total of eight children were treated surgically with Type II or Type III anterior tibial eminence fractures; another four children with undisplaced, Type I fractures were treated conservatively, applying with cast fixation for 6 weeks. Radiological consolidation, stability and functional outcome were assessed during the follow-up examinations.

Results: On the 12th postoperative week, we did not find instability in any of the patients by physical examination. There were only minimal differences found in the functional outcome, comparing the conservatively and operatively treated groups (Lysholm functional scale, average scores: Type I: 97, Type II: 95 and Type III: 94 points). The range of motion (ROM) of the injured knees was identical with healthy sides on the postoperative 6th week.

Conclusions: Our results indicate that the presented method can successfully be applied in the treatment of displaced tibial spine fractures; providing excellent stability and preserving the function of the injured knee in the short-term.

Keywords: Arthroscopy; Cannulated Herbert-screw; Children; Tibial spine fracture.