Comparison of Two Fixation Methods in Treating Displaced Pediatric Tibial Eminence Fractures at Boston Childrens Hospital

Abstract

Introduction: Tibial eminence fractures (TEF) occur most often in children, and disrupt the bony attachment of the anterior cruciate ligament (ACL) to the tibia. Displaced TEF are managed surgically with reduction and fixation of the displaced fragment. This study compares the two most common methods of surgical fixation, suture and screw fixation. Methods: A retrospective case-study review of 78 patients treated at Boston Childrens Hospital for tibial eminence fractures comparing surgical results following suture or screw fixation. Results: Seventy-eight tibial spine injuries were analyzed with an average age at surgery of 11. Thirty-six knees were treated with sutures versus 35 with screws. Sport related injuries were found to be the most common cause of TEF. Mild activity-related pain was reported in 23% of patients. It was noticed that concurrent meniscal pathology leads to statistically significantly higher rates of loss of flexion. The total complication rate of the cohort was found to be 33%. Conclusions: We concluded that no major outcome differences were seen with suture vs. screw fixation. Numerous observations can be made from this study regarding percentage of complications and residual symptoms. Future work will aim to follow patients prospectively for assessment of knee function.