Fractures of the intercondylar eminence in children and adolescents

Abstract

The treatment of choice of completely dislocated fractures of the intercondylar eminence is controversial. Recently, Zifko and Gaudernak [14] introduced a new classification in which they distinguish between two different types of intercondylar fractures: Type A: isolated avulsion of the anterior cruciate ligament Type B: fractures including the intercondylar eminence In order to assess whether this new classification could lead to a better selection of patients requiring open reduction, 19 children were reviewed 2-16 years after they had sustained a fracture of the intercondylar eminence. All patients with incompletely displaced fragments had an excellent or good ultimate result, independent of the kind of initial treatment received. Eleven patients sustained a complete displaced fracture. Of these, two had a poor result. Both had been treated conservatively for isolated avulsion of the anterior cruciate ligament. All conservatively treated type-B fractures had an excellent or good result. It is concluded that completely displaced type-A fractures require operative treatment by open reduction and fixation of the avulsed fragment.

Clinical and radiological results of arthroscopically treated tibial spine fractures in childhood

“…Moreover, they support the opinion that the surgical option facilitates a more satisfactory reduction of the fracture, thus avoiding the possible risk of a meniscal entrapment under the fractured tibial eminence or a possible healing of the fracture in a non-anatomical position, with the consequence of further instability or loss of extension of the knee [4,6,13,19].…”

Tibial eminence fractures in the paediatric population: A systematic review

“…Several older studies have proposed that type II, III and IV fractures do not require fixation [3, 11, 23, 24]. Table 4 outlines differences in management of these fractures patterns.…”

“…Table 4 outlines differences in management of these fractures patterns. Several papers have reported worse results for type III fractures treated non-operatively [3, 14, 30, 32]. A retrospective case study of 61 paediatric patients found a direct correlation between fracture displacement after healing and knee laxity ( r  = 0.74, p  < 0.001) [14].…”

“…The only other paper to report results after excision demonstrated no instability after open excision in four patients [19]. One paper disputed that only the anterior portion of the ACL was involved, and used a classification system in which type A was the anterior portion only, and type B was a fracture of the entire ACL footprint [3]. Advocates of excision discuss the benefits of early weight bearing and mobilisation [15].…”

Surgical management of type II tibial intercondylar eminence fractures in children

“…This variation is because of an increase in the local blood supply during the healing stage [29]. This modification is usually asymptomatic and is not associated with knee flexion [25,30], because of the median situation of the callus [5]. The curettage of the fracture area before internal fixation, in our experience, allowed elimination of the variation of the shape and size of the tibial intercondylar eminence.…”