Background: Although open reduction and internal fixation are recommended for displaced tibial tubercle avulsion fractures in young athletes, whether to use unicortical or bicortical fixation is debatable. The purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures. Methods: We reviewed a consecutive series of patients with tibial tubercle fractures treated surgically at 2 level-1 pediatric tertiary care centers over a 12.5-year period. Patients aged below 18 years of age who received surgical treatment for displaced tibial tubercle fractures with postoperative follow-up were included. Fractures were classified using a modified Ogden classification system. The relative proportion of fracture types treated and incidence of complications were compared. Results: The cohort included 90 fractures in 86 patients. There were 82 male and 4 female individuals; average age was 14.7 years (range, 9.0 to 18 y). In total, 87 of 90 were treated with open reduction and internal screw fixation [51 unicortical (59%), 13 mixed (15%), 23 bicortical (26%)] and 3 with percutaneous pinning. All patients were followed-up until healing and postoperative follow-up average was 8 months (range, 3 to 34 mo). There were no significant differences between the 2 groups with regard to patient age (P=0.22), patient weight (P=0.22), and activity clearance times [unicortical: 19.9 wk (range, 10.4 to 42.3 wk); bicortical: 17.7 wk (range, 12.1 to 32 wk); P=0.19]. The mixed cortical group was cleared at an average of 19.9 weeks (range, 10.6 to 29.1 wk). The relative proportion of fracture patterns treated differed negligibly between the unicortical and bicortical groups. Complications were noted in 9 of 90 procedures (10% rate); all subjects showed evidence of full radiographic healing at last follow-up. Conclusions: There was no difference in outcome whether unicortical or bicortical fixation was used. All patients exhibited full healing and return to activities with very low-complication rates. The results of this study suggest the adequacy of unicortical fixation for treating tibial tubercle fractures in young athletes. Level of Evidence: Level III—retrospective comparative study.

3.

Metal-on-metal (MoM) hip resurfacing has been used in many young, active patients, including women of childbearing age. While ion levels have been measured in mothers with MoM hip resurfacing and their babies, little is known about how these ions affect child development. Out of 1300, MoM hip resurfacing surgeries, we had 48 women of childbearing age (defined as 40 years of age or younger at the time of surgery). These women were contacted to see if they had had pregnancies after their surgery, and those who had were sent surveys asking about their pregnancies and the development of their children. Eleven women reported pregnancies, and eight returned the surveys. There were no significant differences between women with pregnancies and those without pregnancies in any demographic or clinical measures. From the eight women who completed surveys, there were seventeen pregnancies resulting in fourteen births. There were complications in three of the births resulting in two premature births, but no children were born with birth defects. Overall, the children appear to be developing normally. Based on this unique data, we do not feel that MoM hip resurfacing is contraindicated for women of childbearing age, but power analyses show that we cannot draw conclusive results from our sample. We recommend that other groups publish their own data to allow us to generate sufficient sample sizes to draw meaningful conclusions.

No abstract

Level II, prognostic.