Tibial Spine fractures are similar to ACL injuries in
adults. It occurs due to hyperextension of the knee and is commonly seen during
falls from a bicycle. An injured child with a swollen knee and who has fallen
from a bicycle should alert the clinician to the possibility of a tibial spine
fracture. A meniscal injury may also occur, especially with the medial
meniscus. The interposition of the meniscus or rotation of the fracture may
prevent a closed reduction.
Tibial spine fractures are classified using the Meyers and
McKeever Classification and are separated into three types. Type I
classifications are nondisplaced, Type II fractures are identified as being
minimally displaced with an intact posterior hinge, and Type III fractures are
classified as being completely displaced.
The presentation and examination is similar to an ACL tear
with immediate swelling as well as a positive Lachman’s Test or Anterior Drawer
Test. An x-ray will show the fracture and a CT scan will help in planning for
surgery. An MRI may be required to show a trapped or a meniscal injury.
Treatment
Treatment will consist of an aspiration of the large
hematoma. Nonoperative treatment is used for Type I fractures and reducible
Type II fractures; a closed reduction and immobilization in 0-20 of flexion. Surgery
is performed in Type II fractures and unreducible Type II fractures. An ORIF or
arthroscopic reduction and fixation will be performed. During surgery, the
trapped meniscus will be moved out of the way and the surgeon will use sutures
or screws for fixation. It is important for the surgeon to remember to avoid
the physis.
Complication
ACL laxity is common but not clinically significant. Stiffness
or arthrofibrosis occurs with surgical fixation. Growth arrest is rare.
