[Fractures of the intercondylar eminence of the tibia].
ABSTRACT We analyzed a group of patients surgically treated for fractures of the intercondylar eminence of the tibia in the Department of Orthopedics in Pilsen between 1992 and 2002, and evaluated the results of this treatment on the basis of objective examination and comparison with the relevant literature data. We describe indications for surgical treatment and the surgical methods used, including different fixation materials.
In the period from 1992 to 2002, 27 patients underwent surgery for a fracture of the intercondylar eminence of the tibia in our Department. The group included 19 men and 8 women aged between 8 and 49 years; the average age was 16.2 years.
Surgery was indicated in type II and type III fractures of the intercondylar eminence of the tibia, as classified according to the Meyers and McKeveer system. Medial arthrotomy was used in 16 patients, nine of whom had undergone diagnostic arthroscopy. Arthroscopic surgery from the classical, either anterolateral or anteromedial, approach was performed in 11 patients. After arthroscope insertion, the knee joint was irrigated and inspected. The meniscus or transversal ligament, if interpositioned, were released and, subsequently, a dislocated fragment was reduced and fixed. Fixation was carried out with a Kirschner's wire, cannulated screw, wire loop or absorbable suture.
The patients were examined in 2003, after a follow-up ranging from 1 to 10 years. A total of 17 patients turned up. The outcome of treatment was evaluated on the basis of X-ray and clinical findings. Union of the eminence in an appropriate position was found on X-ray films in all patients. Clinical evaluation included the range of motion and knee joint stability. Restricted motion was found in three patients. No positive anterior drawer or Lachman's tests were recorded.
No failure of osteosynthesis was recorded in our patients although different fixation materials were used. This is in agreement with the results of other authors who did not report any failure of osteosynthesis due to insufficient stability provided by different fixation materials. The outcomes of surgical treatment in comparable patient groups were also similar.
Arthroscopy is considered the most suitable technique for the treatment of fractures of the intercondylar eminence of the tibia, because it is minimally invasive and provides a good view of the operative field. The outcome of surgery is not dependent on the fixation material used. However, metal implants, in contrast to absorbable materials, have to be removed in an additional surgical procedure.
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ABSTRACT: Die Refixation dislozierter Ausrissfrakturen der Eminentia intercondylaris wird zur Erhaltung der vorderen Kreuzbandfunktion und damit der Kniegelenkstabilität in der Literatur einheitlich empfohlen. Sowohl die arthroskopische Eminentiaverschraubung als auch die transtibiale Fadenfixation stellen bzgl. ihrer Resultate und Komplikationsraten geeignete operative Methoden dar. Aufgrund ihrer minimaleren Invasivität und der die Epiphysenfugen nicht tangierenden Lage des Fremdmaterials geben wir der arthroskopisch assistierten Schraubenrefixation, insbesondere auch bei kindlichen Verletzungen, den Vorzug. Der vorliegende Beitrag erläutert die Empfehlungen der aktuellen Literatur, stellt die Vor- und Nachteile einzelner chirurgischer Lösungsansätze zur Diskussion und präsentiert eigene Ergebnisse und Erfahrungen. To restore anterior cruciate ligament (ACL) function and therefore knee joint stability surgical refixation of ACL avulsion fractures is a unanimous recommendation in the literature. Both arthroscopic screw fixation and transtibial suture fixation are appropriate surgical procedures regarding results and complication rates. Based on minimally invasive and minor effects on epiphyseal growth plates, we prefer arthroscopically assisted cannulated screw refixation, especially in skeletally immature patients. The present article comments on the recommendations from the current literature, discusses benefits and adverse effects of several surgical approaches and demonstrates own results and experiences. SchlüsselwörterKnöcherner vorderer Kreuzbandausriss-Kanülierte Schraubenrefixation-Eminentia intercondylaris KeywordsAnterior cruciate ligament avulsion-Cannulated screw fixation-Intercondylar eminenceArthroskopie 06/2010; 23(2):92-96. DOI:10.1007/s00142-009-0553-8
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ABSTRACT: The objective of this study is to report the clinical and radiological long-term follow-up evaluation of young patients arthroscopically treated for anterior tibial eminence fracture. Ten patients (mean age: 13.5 years) were treated between 1992 and 2006. At follow-up they were clinically and radiologically evaluated. Moreover, they underwent assessment with the International Knee Documentation Committee (IKDC) forms, Lysholm and Tegner knee scales and measurement with the KT-1000 arthrometer. At a mean follow-up of 85.8 months, all of the patients reported a subjective good-excellent outcome. Objectively, the Lachman test was negative in seven patients and positive in three patients; six patients (60%) registered a slight (+) to mild (++) pivot-glide test. The mean value of KT-1000 arthrometer measurements was 3 mm; all knee scales showed satisfactory results. Radiological exam always showed good healing of the fracture. Fractures of the tibial spine often lead to anterior and rotational knee laxity. However, despite this instrumental finding, patients usually do not report any type of restriction in their functional or sports activities.International Orthopaedics 12/2008; 33(1):243-8. DOI:10.1007/s00264-008-0697-6 · 2.02 Impact Factor
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ABSTRACT: Frakturen und knöcherne Bandausrisse rund um das Kniegelenk zeigen im Wachstumsalter auf Grund zunehmend frühzeitiger Aufnahme intensiver sportlicher Aktivität eine steigende Inzidenz. Die Folgen von Begleitverletzungen und Schäden an den Epiphysenfugen können bei inadäquater Therapie mitunter stark einschränkend sein. Der vorliegende Beitrag erläutert die prognostische Bedeutung und das diagnostische und therapeutische Vorgehen bei kniegelenknahen Frakturen des distalen Femurs und der proximalen Tibia im Kindes- und Jugendalter, die sich aus extraartikulären metaphysären Frakturen, Frakturen mit Beteiligung der Wachstumsfugen und knöchernen, rein epiphysären Bandausrissen zusammensetzen. Fractures and ligament avulsions around the knee joint are becoming increasingly more common injuries in adolescence due to the earlier inception of high-risk competitive sports. The long-term effect of concomitant lesions and damage to the epiphyseal growth plates can be restrictive, if therapeutic algorithms are inadequate. The present article comments on the prognostic importance and the diagnostic and therapeutic procedures for fractures of the distal femur and the proximal tibia in skeletally immature patients, which consist of extraarticular metaphyseal fractures, fractures involving the epiphyseal growth plates and bony, purely epiphyseal ligament avulsions.Arthroskopie 02/2008; 22(1):14-20. DOI:10.1007/s00142-008-0499-2