[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: Fractures of the tibial intercondylar eminence are observed mostly in children and adolescents, often after minimal trauma. The purpose of this paper is to evaluate the use of K-wire fixation for the arthroscopic treatment of tibial eminence fractures in children. From January 2002 through January 2009 ten patients were treated arthroscopically because of the intercondylar eminence fracture in a Department of pediatric surgery, University Hospital Split. Arthroscopically controlled reposition was done, and using mobile X-ray two crossed K-wires were introduced percutaneously from the proximal part of the tibia to the fractured intercondylar eminence. Subjective outcome was obtained using IKDC subjective questionnaire. Average hospitalization time was 11 days. Average duration of treatment was 12.5 weeks. Average follow-up was 42 months. Follow-up radiographs showed union in all cases. The mean IKDC subjective score was 96/100. Clinically, all patients exhibited a solid endpoint on the Lachman test. The global IKDC objective score was normal in eight knees and nearly normal in two knees. Arthroscopic reduction and fixation by Kirschner wires or a small fragment screw is the best way for treatment intercondylar tibial eminence fractures, in the pediatric population, because is not crossing the epiphyseal plate.Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 01/2010; 99(1):38-44. · 1.17 Impact Factor
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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 01/2010; 23(2):92-96.
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ABSTRACT: BACKGROUND: In 1995, we developed a simple and safe arthroscopic technique of anterograde stable fixation of the displaced tibial eminence fractures using a cannulated screw and washer, allowing immediate mobilisation and weight bearing. Some authors described similar end results by arthroscopic fixation of this abruption with trans-osseous sutures. We proved with the biomechanical study that the fixation with strong trans-osseous sutures provides a comparable stable fixation the same as the cannulated screw and washer. We developed a test machine for cyclic loading and a machine for measuring of the pull-out strength for this study. METHODS: A standard osteotomy of the tibial spine was performed during the cadaveric biomechanical study. We performed an arthroscopic fixation with the cannulated screw and washer in ten knees, and in another group of ten knees, arthroscopic fixation was made using two trans-osseous Orthocord™ sutures. The operating time for each procedure was measured, and any possible technical complications were recorded. One thousand cycles of flexion from 0° to 90° were performed on a special loading device on all knees. The macroscopic dislocation of the fragment was measured. After the cyclic loading, all soft tissue was resected except the anterior cruciate ligament with the fixed fragment. The pull-out strength defined as translation of the tibia in anterior direction by breakage was measured with a custom-made measuring device. RESULTS: The average time for the screw and washer fixation was 20 min, and average time for the sutures fixation was 48 min. After cyclic loading, we did not see any dislocation of the fragment. Average pull-out strength at which fixation with a cannulated screw and washer fell was 253.42 N and mean pull-out strength at which fixation with trans-osseous sutures fell was 330.32 N. Fixation of the fragment with trans-osseous sutures was statistically significantly stronger-Wilcoxon-Mann-Whitney's test, p = <0.00. CONCLUSION: Fixation with strong trans-osseous sutures is stronger than fixation with a cannulated screw and washer on cadaveric knees. It appears that fixation with strong trans-osseous sutures allows immediate mobilisation and weight bearing like fixation with a cannulated screw and washer. Meanwhile, the time for fixation with trans-osseous sutures is significantly longer.European Journal of Orthopaedic Surgery & Traumatology 02/2013; · 0.18 Impact Factor