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Tibial spine avulsion fractures

treatment update

Tuca, Mariaa; Bernal, Naziraa; Luderowski, Evab; Green, Daniel W.c

doi: 10.1097/MOP.0000000000000719
ORTHOPEDICS: Edited by Daniel W. Green

Purpose of review The purpose of this review is to summarize and clarify the current framework for treating tibial spine avulsion fractures (TSAFs). We will discuss how these fractures are classified both on plain radiographs and MRI as well as report the incidence of concomitant soft tissue injury, an important consideration that guides treatment. We will also compare guidelines for nonsurgical versus surgical treatment and summarize frequently used surgical techniques. Finally, we will review outcomes following treatment, including common complications.

Recent findings Although TSAFs only constitute 2–5% of all pediatric knee injuries, the incidence is increasing. A recently developed MRI-based system for evaluating TSAFs is another tool that aids in the treatment of these injuries.

Summary TSAFs can be classified using plain radiographs as well as MRI. Type I fractures are usually treated with immobilization whereas type II fractures typically undergo an initial attempt at closed reduction followed by arthroscopic or open reduction and fixation if needed. Type III fractures are indicated directly for arthroscopic surgery and both suture and screw fixation produce good clinical outcomes. All-epiphyseal or transphyseal approaches can minimize the risk of physeal injury in skeletally immature patients. Common complications following TSAF injury and treatment are residual laxity, knee stiffness, and nonunion or malunion.

aClinica Alemana, Universidad de Desarrollo, Santiago, Chile

bJohns Hopkins University School of Medicine, Baltimore, Maryland

cHospital for Special Surgery, New York, New York, USA

Correspondence to Maria Tuca, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. E-mail:

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