Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study.

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Abstract

Conflict of interest statement: One or more of the authors declared the following potential conflict of interest or source of funding: J.A. has received educational support from Pylant Medical, Smith & Nephew, and Arthrex. D.K. has received educational support from Kairos Surgical. M.S.K. has received consulting fees and royalties from OrthoPediatrics and Ossur, nonconsulting fees from Smith & Nephew, and honoraria from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. 14. Injury. 2018 Nov;49 Suppl 3:S48-S53. doi: 10.1016/j.injury.2018.09.055. Intercondylar eminence fracture treated by resorbable magnesium screws osteosynthesis: A case series. Gigante A(1), Setaro N(2), Rotini M(3), Finzi SS(3), Marinelli M(4). Author information: (1)Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy. Electronic address: a.gigante@univpm.it. (2)Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy. Electronic address: nicola.setaro@libero.it. (3)Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy. (4)Clinic of Adult and Paediatric Orthopaedic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy. INTRODUCTION: Tibial spine avulsion fractures are mostly a paediatric injury which appropriate treatment is currently debated in literature. The choice between conservative and surgical treatment is based on the radiographic classification of Meyers-McKeever. The most diffused surgical techniques involve either internal fixation devices (screws) or bone tunnels fixation with resorbable sutures. Today, a third option is represented by resorbable magnesium screws which could combine the best features of the two classical systems. Objective of this study is to investigate the efficacy of these new devices in the surgical treatment of tibial spine avulsions. MATERIALS AND METHODS: Since 2014 we have seen seven patients with tibial eminence fracture. Patients underwent clinical and radiological examination (MRI, CT scan) before surgery. Only 3 patients that presented with a grade III or IV lesion were treated surgically with internal fixation with magnesium resorbable screws. In post-operative follow-up, functional recovery was evaluated at 1, 2, 4, 6 and 12 months, clinically and by X-ray. Lysholm and IKDC scores were submitted at 1, 2, 6 and 12 months. MRI was repeated at 6 and 12 months. RESULTS: All three surgical patients showed progressive clinical and functional improvement during the follow-up period. The first case showed a quicker overall recovery rate, which might be due to the lower grade of the lesion. Radiographs and MRI evaluation showed regular healing of the injury. The devices appeared completely resorbed at the 6 months follow-up and replaced by newly formed bone at the 12 months follow-up. CONCLUSIONS: The treatment of tibial spine avulsion fractures with arthroscopic reduction and internal fixation (ARIF) technique by magnesium resorbable screws seems to result in an excellent functional recovery without complications related to fixation devices, which were completely resorbed after 6 months and replaced by newly formed bone after 12 months. This new method could be considered as an alternative option to classic techniques by non resorbable fixation devices or bone tunnel fixation. Further studies are needed in order to evaluate the efficacy of these new devices in a wider group of patients. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved. DOI: 10.1016/j.injury.2018.09.055