PURPOSE To compare operative results between pull-out wiring and retrograde screw fixation for displaced tibial intercondylar eminence fracture. MATERIALS AND METHODS From March 1997 to February 1999, authors carried out pull-out wiring in 3 patients and retrograde screw fixation in 5 patients who sustained typeII and typeIII displaced tibial intercondylar eminence fractures follow up for 16 months(mean). RESULTS The Union time was mean 7 wk in pull-out wiring and 6.5 wk in retrograde screw fixation. Limitation of knee motion(1 case) developed in retrograde screw fixation group and reoperated for adhesiolysis. Pull-out wiring group were all full motion recovered. Anterior instability(1 case) developed in retrograde screw fixation group and pull-out wiring group had no instability. Operation time for retrograde screw fixation group was mean 98min and pull-out wiring group was 105 min. CONCLUSION The outcome of pull-out wiring group were superior to retrograde screw fixation group. It can be stably fixed and allow early motion exercise. Besides, in case of small bony fragment, it is difficult for fixation with screw. And even impossible. In child cases, the multiple percutaneous pinning can lead to good result. So authors believe that pull-out wiring is worthy for tibial intercondylar eminence fracture.
Fracture of tibial intercondylar eminence has a clinical importance in aspect of associated ligament injury, limited range of motion and joint instability The purpose of this study is to evaluate the intercondylar eminence fracture and to compare the results of treatment by method of arthroscopic reduction and pull-out suture with results of conservative treatment. The results were evaluated with Mayers and Mckeevers criteria of result and instability. 23 cases of avulsion fracture of tibial intercondylar eminence were reviewed. Most common type was type II Most common cause was traffic accident. Closed reduction and cast immobilization was performed in 12 cases, of which 10 cases had above good result initially, reduction with pull-out suture by arthroscopy was performed in 11 cases, of which 10 cases had above good refult. Type III B fracture were reduction with minimal arthrotomy because of the arthroscopic reduction was difficult. 2 cases of instability were in type III A and type III B. An instability case of type III A was treated non-operatively and the other of type III B was treated pull-out suture. 1 case of extension limitation was in type II which waf treated non-operatively because of multiple injury.
Avulsion fracture of the intercondylar eminence of the tibia(Type III as classified By Meyers and Mckeever) can be managed by arthroscopic reduction and fixation. Recently, the different arthroscopic suturing techniques, fixation with K-wire, screw and staple fixation have been employed to treat this injuries, however, most of these techniques are complicated and they do not always achieve stable fixation enough to facilitate early rehabilitation and restore stability to the knee through a full range of motion so far. A new technique for treatment of the tibial spine fracture arthroscopically, using the tension band method is presented.
The advantage of this method include : 1. to be technically less demanding.
2. to allow for stable fixation even thin or comminuted fragments.
3. to present simple and safe removal of internal fixation.
4. to facilitate early rehabilitation.