Suture Versus Screw Fixation of Displaced Tibial Eminence Fractures: A Biomechanical Comparison

Bong, Matthew R.; Romero, Anthony; Kubiak, Erik N.; Iesaka, Kazuho; Heywood, C; Kummer, F; Rosen, Jeffrey; Jazrawi, Laith M.

doi:10.1016/j.arthro.2005.06.019

Cited by 109 publications

(111 citation statements)

References 29 publications

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“…5) metal screws [82][83][84][85], bioabsorbable nails [86], Kirschner wires [36,41,43,76], or suture anchors [87,88]. Several reports have found that screws can actually weaken the small fragment or cause comminution [78] and thus recommend suture fixation, which has demonstrated similar or improved strength profiles [89][90][91]. Typically some sort of visualization is required to reduce the fracture fragment as there is a high likelihood of entrapment of the intermeniscal ligament or the anterior horn of the medial or lateral meniscus [12,84].…”

Section: Tibial Eminence Fracturementioning

confidence: 99%

Pediatric ACL injuries: evaluation and management

Mall¹,

Paletta

2013

Curr Rev Musculoskelet Med

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The anterior cruciate ligament (ACL) is a stabilizing structure to both anterior translation of the tibia with respect to the femur as well as rotation of the knee joint. Children and adolescents are susceptible to these injuries, and there are some who believe the incidence of ACL injuries in this population is increasing due to year round single sport participation. Pediatric ACL injuries are typically seen in several forms: tibial avulsion fractures, partial ACL tears, and full thickness ligament tears. There were and still are some who feel that ACL injuries should be treated non-operatively in the pediatric and adolescent population; however, recent literature refutes this notion. Several factors must be considered during pediatric and adolescent ACL reconstruction, each of which will be examined in this manuscript, including: status of the physis, reconstruction technique, and graft source.

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Section: Tibial Eminence Fracturementioning

confidence: 99%

Pediatric ACL injuries: evaluation and management

Mall¹,

Paletta

2013

Curr Rev Musculoskelet Med

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“…Suture fixation has the advantage of avoiding the physis. Biomechanical studies have shown that sutures may also be stronger in strength than screw fixation [43]. Ultra-high-molecular-weight polyethelene (UHMWPE) suture fixation was found to be stronger than PDS or screw fixation [44].…”

Section: Surgical Techniquesmentioning

confidence: 99%

Physeal fractures about the knee

Little

Milewski

2016

Curr Rev Musculoskelet Med

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While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently. A thorough understanding of the pertinent developmental anatomy is critical for correlating the clinical findings with the imaging work-up, and for anticipating the most common and the most serious complications of each fracture. Diagnosis is usually made with appropriate plain radiographs with advanced imaging often used for preoperative planning. In general, fracture pattern and degree of displacement determine the need for surgical intervention and the overall outcome. While a variety of fixation techniques or constructs may be used, because of the importance of restoring physeal and articular anatomy for avoidance of growth disturbance and degenerative joint disease, respectively, achieving anatomic, rigid fixation is of greater importance than with many other fracture locations in the growing skeleton.

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“…28,29 Success in treating tibial eminence fractures is dependent on secure fixation, which can allow for early postoperative knee mobilization, decreased risk of arthrofibrosis, and a more rapid return to full activity. 33,35 Bong et al 31 conducted a biomechanical study in cadaveric models comparing the properties of cannulated screws with suture tied over an anterior tibial bone bridge and found that there was no significant difference between the mean stiffness achieved. They did, however, find that the ultimate strength of suture fixation of tibial eminence fractures was significantly greater than that of cannulated screw fixation.…”

Section: Hybrid Fixation Of Tibial Eminence Fracturesmentioning

confidence: 99%

“…28,29 However, a number of these techniques violate the growth plate, and in the case of metal screw fixation, retained hardware can result in the need to reoperate to remove hardware. Within the orthopaedic community, questions about which is the strongest method of fixation with the greatest stability remain, 28,30,31 with some surgeons favoring suture fixation 26 and others preferring screw fixation. [32][33][34] In this article we present arthroscopic techniques for growth plateesparing tibial eminence fracture fixation in skeletally immature patients using both resorbable headless screws and sutures.…”

mentioning

confidence: 99%

Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients

Gans

Babatunde

Ganley

2013

Arthroscopy Techniques

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Tibial eminence fractures most commonly occur in children and adolescents. When treating displaced fractures of the tibial eminence, some surgeons prefer screw fixation whereas others prefer suture fixation. The ultimate goal is to limit morbidity through early return to range of motion and activity. In this technical note, we describe 2 hybrid fixation techniques for fixing tibial eminence fractures, one for type III and the other for type IV fractures. The first technique (variation A) is used to treat type III fractures and combines use of both a bioabsorbable compression screw and suture for fixation. The second technique (variation B) is used to treat type IV fractures and combines use of both a bioabsorbable compression screw and shoulder anchor fixation. We have found that these methods provide efficient, secure, and reliable fixation using standard techniques common to arthroscopic surgery. In addition, the growth plates are spared in children and adolescents, and the need for reoperation to remove hardware is eliminated.

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Suture Versus Screw Fixation of Displaced Tibial Eminence Fractures: A Biomechanical Comparison

Cited by 109 publications

References 29 publications

Pediatric ACL injuries: evaluation and management

Pediatric ACL injuries: evaluation and management

Physeal fractures about the knee

Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients

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