Fractures of the intercondylar eminence of the tibia in children:: a 25 cases report with a 1 to 20 years follow-up

Purpose of the study This study tries to clarify the diagnostic strategy in intercondylar eminence fractures of the tibia and aids the deduction of therapeutic options based on the analysis of the long-term morbidity of anterior laxity. Material and methods This retrospective, monocentric study of 25 children with a mean age of 11.8 years (7-15 years) was performed with an average follow-up of 7.2 years (1-20 years). Fractures are itemized with Meyers-McKeever modified by Zaricznyj and Zifko-Gaudernak classifications. Conservative treatment (16 patients) consisted of hemarthrosis aspiration, ligament examination, manipulation into extension and cast immobilization under general anesthesia. Surgical treatment (9 patients) consisted of wire suture fixation (4 times), wire suture fixation held by a screw (3 times) and direct screw fixation (2 times). Four patients were lost to follow-up. Patients were evaluated with the Lysholm (21 patients) and IKDC (15 patients) scores systems. Anterior laxity was checked with a KT-1000 arthrometer, Antero-posterior and lateral X-rays were performed. The statistical analysis was carried out with Mann-Withney and Fischer tests. Results There are 18 good or very good results and only 3 medium with the Lysholm score and 5 knees graded A, 9 graded B and 1 graded C with the IKDC score. Mean anterior laxity is 1.86 mm (0 to 4 mm) after conservative treatment and 1,5 mm (-1 to 4 mm) after operative treatment. 5 patients have an anterior laxity and only 2 an anterior instability No arthritic lesions, 1 nonunion, and 11 malunions have been observed, mainly after conservative treatment. Discussion Ligament examination under general anesthesia is useless for displaced fractures and dangerous for those were not displaced, Diagnostic arthroscopy is not yet allowed. Magnetic Resonnance Imaging is useful to explore osteochondral fractures and symptomatic meniscal lesions. Laxity is the consequence of anterior cruciate ligament elongation. Conclusion The diagnosis of these fractures rests on a simple radio-clinical examination to determinate the exact position, the deplacement and the size of the osteochondral fragment in order to choose the best treatment. Conservative treatment will be chosen preferentially because of a poor long-term morbidity. Treatment will be surgical, preferably arthroscopic, in the others cases.