Arthroscopic versus closed reduction for displaced tibial spine fractures in children

Abstract

Objective To compare the efficacies of arthroscopic reduction with internal fixation using bioabsorbable nails (group I) versus closed reduction with cast immobilization (group II). Methods A retrospective case-control study was conducted for type III tibial spine fractures according to the Meyers criteria. Twelve skeletally immature patients undergoing arthroscopic reduction with internal fixation using bioabsorbable nails (group I) were compared with 12 age and gender-matched skeletally immature counterparts undergoing closed reduction with cast immobilization (group II). During a follow-up period of 18-48 months, all subjects were evaluated with anterior knee laxity (Lachnmn & pivot-shift tests), range of motion, Lysholm knee scoring scale and Wilfinger X-ray classification. Results Significant inter-group differences existed in range of motion (0/12 vs 2/12), Lysholm knee scoring scale (U=16.500, W=94.500, Z=-3.273, P=0.001<0.05) and X ray(χ2=10.667, P=0.003<0.05). The range of motion was normal for all knee joints. The functions of all knees were excellent according to the Lysholm knee scoring scale. Only 2 were fair or poor according to the Wilfinger X-ray classification. There was no inflammation and all fractures healed without complications. In group II, Lachnmn test (n=5) and pivot-shift test (n=2) were positive. In 2 patients, the range of motion was abnormal for knee joints (5-10 degree limited extension). Three of them were fair according to the Lysholm knee scoring scale. And 10/12 patients were fair or poor according to the Wilfinger X-ray classification. Conclusions As compared with closed reduction with cast immobilization, arthroscopic reduction with internal fixation for tibial spine fractures can regain full stability and good function of knee joint. Bioabsorbable nail has the advantages of simpler handling and more stable fixation. Thus a second operation for removing metallic implants is avoided. Key words: Surgical procedures, arthroscopic; Child; Tibial fractures