[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.
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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
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ABSTRACT: This retrospective study seeks to clarify diagnostic strategy in intercondylar eminence fractures of the tibia in children and to deduce therapeutic options based on analysis of long-term morbidity of anterior laxity.Twenty-five patients, aged on average 11.8 years, sustained a tibial spine fracture. Average follow-up was 7.2 years. Lesions are listed according to Meyers'' classification  as modified by Zaricznyj  and that of Zifko . Nonoperative treatment (16 patients) included reduction in hyperextension after hemarthrosis aspiration, ligament examination manipulation into extension and cast immobilization under general anesthesia.Surgical treatment (9 patients) consisted of wire suture in 4 cases, wire suture held by a screw in 3 cases, and direct screw fixation in 2 cases. 4 patients were lost to follow-up. Patients were evaluated by the Lysholm (21 cases) and IKDC (15 cases) score systems. Ligamentous laxity was measured with a KT-1000 arthrometer.Statistical analysis was carried out with the Mann-Whitney and Fischer tests. The Lysholm score indicates 18 good or excellent results and only 3 medium. The overall IKDC score indicates 5 knees graded A, 9 graded B and one graded C. Mean laxity was 1.85 mm (o to 4 mm) after conservative treatment and 1.5 mm (–1 to 4 mm) after surgical treatment (p not significant). 5 patients in the review had laxity, only 2 of whom also had anterior instability. Antero-posterior ligament examination serves no purpose for very displaced fractures, and can be dangerous for those which are not displaced, or only slightly. Purely diagnostic arthroscopy cannot be justified in these cases. Magnetic resonance imaging should be reserved for cases of osteochondral fractures and symptomatic meniscal lesions. Laxity is the result of anterior cruciate ligament elongation.Diagnosis of these fractures relies on simple radio-clinical examination in order to determine the exact site, displacement and size of the osteochondral fragment, enabling the best treatment to be selected. Conservative treatment should be chosen whenever possible where low long-term morbidity is expected. Surgical treatment, probably with arthroscopy, should be used in other cases.Cette tude rtrospective porte sur 25 patients d''ge moyen de 11,8 ans ayant prsent une fracture des pines tibiales. Le recul moyen est de 7,2 ans. Les lsions sont rpertories selon les classifications de Meyers modifie par Zaricznyj et celle de Zifko. Le traitement orthopdique (16 patients) comprend une rduction en hyperextension aprs ponction vacuatrice et testing ligamentaire sous anesthsie gnrale. Le traitement chirurgical (9 patients) consiste en un laage simple 4 fois, un laage mont sur une vis d''appui 3 fois ou un vissage direct 2 fois. 4 patients sont perdus de vue. Les patients sont valus par le score de Lysholm (21 recontacts) et la fiche IKDC (15 revus). La laxit ligamentaire est tudie avec un KT-1000. L''analyse statistique est ralise grce aux tests de Mann-Withney et Fischer.Le score de Lysholm moyen retrouve 18 bons ou trs bons rsultats et seulement 3 moyens. Le score IKDC global retrouve 5 genoux nots A, 9 nots B et 1 not C. La laxit moyenne est de 1,85 mm (o 4 mm) aprs traitement orthopdique et de 1,5 mm (–1 4 mm) aprs traitement chirurgical (p non significatif). Une laxit est prsente pour 5 des patients revus associe seulement 2 cas d''instabilit antrieure.L''examen ligamentaire antro-postrieur sous anesthsie gnrale est inutile dans les formes trs dplaces, voire dangereux dans les formes non ou peu dplaces. L''arthroscopie purement diagnostique ne se justifie pas dans ces fractures. L''imagerie par rsonnance magn tique sera rserve la recherche d''une fracture ostochondrale ou d''une lsion mniscale symptomatiques. La laxit observe est due la dformation plastique du ligament crois antrieur.Le diagnostic de ces fractures repose sur un examen radio-clinique simple dterminant le sige exact, le dplacement et la taille du ligament ostochondral permettant de choisir le traitement le plus adapt. Le traitement orthopdique sera privilgi chaque fois que cela est possible du fait d''une faible morbidit long terme. Le traitement sera chirurgical, plutt men sous arthroscopie dans les autres cas.European Journal of Orthopaedic Surgery & Traumatology 01/1999; 9(3):185-193. · 0.18 Impact Factor