Traitement des factures de l'épine tibiale chez l'enfant. A propos de 25 cas avec un recul de 1 à à 20 ans

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 [36] as modified by Zaricznyj [58] and that of Zifko [59]. 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.