Tibial Spine Fractures in Children

TIBIAL SPINE FRACTURES IN CHILDREN

• Fracture of tibial spine occur in skeletally immature patients
• It is similar to ACL injury in adults

Mechanism : hyperextension injury of knee.

• Most common presentation is giving a history of fall from bicycle ,so an injured child who is brought to the emergency /OP with complaints of pain and swelling around knee should alert the clinician to the possibility of tibial spine fracture.
• It may be associated with meniscal injury , if so most commonly Medial meniscus
• The interposition of the meniscus or rotation of fracture may prevent closed reduction .

MEYERS & McKEEVERS Classification :
• Type I : undisplaced
• Type II : minimally displaced , intact posterior hinge
• Type III : completely displaced
• Type IV: comminuted

PRESENTATION :immediate swelling of knee ,positive Lachman’s test / anterior drawer test .

RADIOLOGICAL INVESTIGATION :

• X RAY : to detect fracture
• CT Scan: will help in planning the line of management
• MRI : to detect meniscal injury /trapped meniscus .

TREATMENT :

First line : initially aspiration of large hematoma .

Non operative:

• for type I and reducible type II fracture
• Closed reduction with immobilization in 0-20 0 flexion

Operative :
• for type III and non reducible type II fracture .
• Open reduction /arthroscopic
• Move the trapped meniscus out of the way
• Use sutures or screws for fixation
• Avoid physis

COMPLICATIONS
• ACL Laxity (clinically not significant )
• Stiffness or arthrofibrosis -occurs with surgical fixation
• Growth arrest is rare .

 

Courtesy: Prof Nabile Ebraheim, University of Toledo, Ohio, USA