[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: 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
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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. DOI:10.1007/BF00542590 · 0.18 Impact Factor
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ABSTRACT: Results obtained from the surgical treatment of 15 cases of type II and III tibial intercondylar eminence fractures-according to the classification of Meyers and McKeever [12, 13]-are reported in this paper. The average age of the patients observed was 22 years (range 18-41). All patients underwent an arthroscopic procedure of reduction and fixation. We used a bioabsorbable suture in ten patients and a nonabsorbable suture in five patients. The suture was passed at the ACL insertion, then pulled out through drilled tunnels and tied onto the anterior surface of the tibial metaphysis. Two of the 15 patients treated underwent an additional arthroscopic procedure because of arthrofibrosis, 2 months after the first surgical intervention. All patients were examined clinically and radiographically with an average follow-up of 18 months. According to the IKDC scoring system, recovery of the 13 patients not undergoing additional intervention was graded as normal or near normal. In 14 patients, anterior laxity was inferior to 5 mm at the KT-1000 arthrometer evaluation. Absorbable or nonabsorbable suture fixation is effective for obtaining a secure fixation and achieves good clinical and functional mid-term results.Knee Surgery Sports Traumatology Arthroscopy 08/2003; 11(4):255-9. DOI:10.1007/s00167-003-0373-8 · 2.84 Impact Factor