A Comparison of Nonoperative and Operative Treatment of Type 2 Tibial Spine Fractures. Issue 1 (21st January 2021)
- Record Type:
- Journal Article
- Title:
- A Comparison of Nonoperative and Operative Treatment of Type 2 Tibial Spine Fractures. Issue 1 (21st January 2021)
- Main Title:
- A Comparison of Nonoperative and Operative Treatment of Type 2 Tibial Spine Fractures
- Authors:
- Prasad, Niyathi
Aoyama, Julien T.
Ganley, Theodore J.
Ellis, Henry B.
Mistovich, R. Justin
Yen, Yi-Meng
Fabricant, Peter D.
Green, Daniel W.
Cruz, Aristides I.
McKay, Scott
Kushare, Indranil
Schmale, Gregory A.
Rhodes, Jason T.
Jagodzinski, Jason
Sachleben, Brant C.
Sargent, M. Catherine
Lee, R. Jay - Abstract:
- Background: Tibial spine fractures (TSFs) are typically treated nonoperatively when nondisplaced and operatively when completely displaced. However, it is unclear whether displaced but hinged (type 2) TSFs should be treated operatively or nonoperatively. Purpose: To compare operative versus nonoperative treatment of type 2 TSFs in terms of overall complication rate, ligamentous laxity, knee range of motion, and rate of subsequent operation. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed 164 type 2 TSFs in patients aged 6 to 16 years treated between January 1, 2000, and January 31, 2019. Excluded were patients with previous TSFs, anterior cruciate ligament (ACL) injury, femoral or tibial fractures, or grade 2 or 3 injury of the collateral ligaments or posterior cruciate ligament. Patients were placed according to treatment into the operative group (n = 123) or nonoperative group (n = 41). The only patient characteristic that differed between groups was body mass index (22 [nonoperative] vs 20 [operative]; P = .02). Duration of follow-up was longer in the operative versus the nonoperative group (11 vs 6.9 months). At final follow-up, 74% of all patients had recorded laxity examinations. Results: At final follow-up, the nonoperative group had more ACL laxity than did the operative group ( P < .01). Groups did not differ significantly in overall complication rate, reoperation rate, or total range of motion (all, P > .05). The nonoperative group had aBackground: Tibial spine fractures (TSFs) are typically treated nonoperatively when nondisplaced and operatively when completely displaced. However, it is unclear whether displaced but hinged (type 2) TSFs should be treated operatively or nonoperatively. Purpose: To compare operative versus nonoperative treatment of type 2 TSFs in terms of overall complication rate, ligamentous laxity, knee range of motion, and rate of subsequent operation. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed 164 type 2 TSFs in patients aged 6 to 16 years treated between January 1, 2000, and January 31, 2019. Excluded were patients with previous TSFs, anterior cruciate ligament (ACL) injury, femoral or tibial fractures, or grade 2 or 3 injury of the collateral ligaments or posterior cruciate ligament. Patients were placed according to treatment into the operative group (n = 123) or nonoperative group (n = 41). The only patient characteristic that differed between groups was body mass index (22 [nonoperative] vs 20 [operative]; P = .02). Duration of follow-up was longer in the operative versus the nonoperative group (11 vs 6.9 months). At final follow-up, 74% of all patients had recorded laxity examinations. Results: At final follow-up, the nonoperative group had more ACL laxity than did the operative group ( P < .01). Groups did not differ significantly in overall complication rate, reoperation rate, or total range of motion (all, P > .05). The nonoperative group had a higher rate of subsequent new TSFs and ACL injuries requiring surgery (4.9%) when compared with the operative group (0%; P = .01). The operative group had a higher rate of arthrofibrosis (8.9%) than did the nonoperative group (0%; P = .047). Reoperation was most common for hardware removal (14%), lysis of adhesions (6.5%), and manipulation under anesthesia (6.5%). Conclusion: Although complication rates were similar between nonoperatively and operatively treated type 2 TSFs, patients treated nonoperatively had higher rates of residual laxity and subsequent tibial spine and ACL surgery, whereas patients treated operatively had a higher rate of arthrofibrosis. These findings should be considered when treating patients with type 2 TSF. … (more)
- Is Part Of:
- Orthopaedic journal of sports medicine. Volume 9:Issue 1(2021)
- Journal:
- Orthopaedic journal of sports medicine
- Issue:
- Volume 9:Issue 1(2021)
- Issue Display:
- Volume 9, Issue 1 (2021)
- Year:
- 2021
- Volume:
- 9
- Issue:
- 1
- Issue Sort Value:
- 2021-0009-0001-0000
- Page Start:
- Page End:
- Publication Date:
- 2021-01-21
- Subjects:
- arthrofibrosis -- complications -- nonoperative treatment -- tibial spine fracture
Sports medicine -- Periodicals
Orthopedics -- Periodicals
Arthroscopy -- Periodicals
Arthroplasty -- Periodicals
Knee -- Surgery -- Periodicals
616.7 - Journal URLs:
- http://www.sagepublications.com/ ↗
- DOI:
- 10.1177/2325967120975410 ↗
- Languages:
- English
- ISSNs:
- 2325-9671
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - BLDSS-3PM
British Library HMNTS - ELD Digital store - Ingest File:
- 14910.xml