ORTHOPEDICS: Edited by Daniel W. GreenTibial spine avulsion fractures: treatment updateTuca, Mariaa; Bernal, Naziraa; Luderowski, Evab; Green, Daniel W.cAuthor Information 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: [email protected] Current Opinion in Pediatrics: February 2019 - Volume 31 - Issue 1 - p 103-111 doi: 10.1097/MOP.0000000000000719 Buy Metrics Abstract 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. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.