OSTEOSÍNTESIS DE FRACTURA DE ESPINA TIBIAL ASISTIDA CON ARTROSCOPÍA Y TORNILLO DE COMPRESIÓN TIPO HERBERT, REPORTE DE UN CASO Y REVISIÓN DE LITERATURA.

Abstract

Introduction Tibial spine fractures have a prevalence of 3 per 100,000 people annually. High-energy trauma is the leading cause, followed by low-energy trauma and 40% by multiple trauma. Imaging studies play a crucial role in establishing the diagnosis. It is important to understand that radiography alone does not allow a correct identification of the fracture, so it is necessary to complement it with a CT or MRI scan. The Meyers-McKeever classification divides fractures by their degree of displacement and comminution into 4 types and guides us in the therapeutic decision. The management of these fractures depends on the morphology, soft tissue involvement and the general condition of the patient. Surgical treatment is primarily considered for displaced fractures. Within this approach, the arthroscopy-assisted technique has reported excellent results. with a low complication rate, compared to open techniques, despite the few studies to define the standard Gold treatment. Case description A clinical case of a 32-year-old patient with a posterior tibial spine fracture is reported, who underwent surgery with arthroscopic-assisted osteosynthesis and a 4.5 x 4.0 Herbert-type compression screw with intraoperative arthroscopic images that demonstrated the restoration of joint congruence, without menisci or ligament injury, assessing intraoperative arches of motion from 0 to 90 degrees. In his mediate postsurgical has been started isometric physiotherapy with flexion and extension of the knee from 0 to 90 degrees plus strengthening of the iliac psoas and quadriceps and resume his activities in 2 months after his surgery. Conclusion At present, there is no consensus on the optimal surgical technique due to the lack of clinical trials. More studies of higher quality and sample size are necessary to establish the Gold Standard in the treatment of tibial spine fractures. However, we found that by using Herbert-type compression screws, timely compression of the fracture fragment is achieved in the anatomical reduction. An updated review of the subject and its therapeutic management is carried out.