Tibial intercondylar eminence fractures in children: The long-term perspective - 25/08/10

Doi : 10.1016/j.otsr.2010.01.012

A. Casalonga ^a, S. Bourelle ^a, F. Chalencon ^c, L. De Oliviera ^c, V. Gautheron ^b, J. Cottalorda ^d,^⁎
^a Children’s Surgery Department, Northern Hospital, 2055 Saint-Étienne cedex 2, France
^b Pediatric Rehabilitation Department, Bellevue Hospital, 42055 Saint-Étienne cedex 2, France
^c Orthopedic Surgery Department, Mutualistic Surgical Private Hospital, 3, rue Le-Verrier, 42100 Saint-Étienne, France
^d Pediatric Orthopedics Department, Lapeyronie Hospital, 371, avenue Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France

Corresponding author. Tel.: +33 4 67 33 87 61; fax: +33 4 67 33 82 48.

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Summary

Purpose of the study

To analyze objective and subjective results on medium-term follow-up of intercondylar fractures of the tibia in children.

Material and methods

A retrospective, single-center study of 32 fractures (17 boys, 14 girls) was performed. Fractures were itemized on the Meyers and McKeever classification as modified by Zaricznyj: there were eight type-I, 17 type-II, five type-III and two type-IV fractures. Treatment was conservative for type-I and II fractures (with mild displacement) and for the others surgical. Seven patients were lost to follow-up and one had insufficient follow-up for inclusion. Thirteen patients were assessed on a KT 1000 arthrometer and a dynamometer, and on the IKDC and ARPEGE scoring systems. Ten patients chose to answer only the subjective IKDC questionnaire, by mail.

Results

The mean IKDC score of subjects answering by mail was 91 and of those with clinical examination was 80. Mean ARPEGE score was 8.3. Subjective IKDC score classified four patients as A, four as B, four as C and one as D. Mean difference in tibial anterior translation between affected and unaffected knees was 0.88mm for type I fractures, 0.82mm for type II and 0.30mm for types III and IV together.

Discussion

The mean difference in tibial anterior translation between affected and unaffected knees was greater in patients with conservative treatment (0.96mm for conservative vs. 0.29mm for surgical treatment). Seventy per cent of patients reported pain at follow-up. Only two had pathological knee laxity. Twelve out of thirteen had returned to sport activity, half of them at the same level as before injury.

Conclusion

The cases treated surgically had a better objective result than those treated conservatively. Nevertheless there was no correlation between subjective evaluation and degree of knee laxity. Overall, intercondylar fractures of the tibial eminence in children have good long-term prognosis, at least subjectively. This study shows that, in spite of a very satisfactory subjective result for most patients, results were not so good on objective measures.

Level of evidence: Level IV: retrospective study.

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Keywords : Tibial intercondylar eminence fracture, Child, Adolescent, Skeletally immature athletes, KT 1000 arthrometer