title: Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison.
abstract: OBJECTIVE
  Classification and treatment of tibial eminence fractures are determined by the degree of fragment displacement. A variety of surgical procedures have been proposed to stabilize displaced fractures using both open and arthroscopic techniques. Two common fixation techniques involve use of cannulated screws and sutures tied over an anterior tibial bone bridge. We are unaware of any biomechanical studies that have compared the strength of various techniques of fixation.
  
  
  METHODS
  Biomechanical study in a cadaveric model.
  
  
  METHODS
  Seven matched pairs of fresh-frozen human cadaveric knees were stripped of all soft tissue except the anterior cruciate ligament (ACL). Simulated type III tibial eminence fractures were created using an osteotome. Fragments of each matched pair were randomized to fixation with either a single 4-mm cannulated cancellous screw with a washer or an arthroscopic suture technique using 3 No. 2 Fiberwire sutures (Arthrex, Naples, FL) passed through the tibial base of the ACL and tied over bone tunnels on the anterior tibial cortex. Specimens were then loaded with a constant load rate of 20 mm/min, and load-deformation curves were generated. The ultimate strength and stiffness were computed for each curve. The failure mode for each test was observed. A paired 2-tailed t test was used to determine the statistically significant difference between the two methods.
  
  
  RESULTS
  Specimens fixed with Fiberwire had a mean ultimate strength of 319 N with a standard deviation of 125 N. Those fixed with cannulated screws had a mean ultimate strength of 125 N with a standard deviation of 74 N. This difference was statistically significant (P = .0038). There was no significant difference between the mean stiffness of Fiberwire constructs (63 N; SD, 50 N) and the mean stiffness of the cannulated screw constructs (20 N; SD, 32 N). The failure modes of the Fiberwire constructs included 1 ACL failure, 3 failures of suture cutting through the anterior tibial cortex, and 3 of suture cutting through the tibial eminence fragment. The single mode of failure for the cannulated screw constructs was screw pullout of cancellous bone.
  
  
  CONCLUSIONS
  The initial ultimate strength of Fiberwire fixation of tibial eminence fractures in these specimens was significantly stronger than that of cannulated screw fixation.
  
  
  CONCLUSIONS
  It appears that Fiberwire fixation of eminence fractures provides biomechanical advantages over cannulated screw fixation and may influence the type of treatment one chooses for patients with tibial eminence fractures.
authors.affiliation: Department of Orthopaedics, New York University-Hospital for Joint Diseases, New York, New York 10003, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Bong
authors.forename: Anthony
authors.initials: A
authors.lastname: Romero
authors.forename: Erik
authors.initials: E
authors.lastname: Kubiak
authors.forename: Kazuho
authors.initials: K
authors.lastname: Iesaka
authors.forename: Christian S
authors.initials: CS
authors.lastname: Heywood
authors.forename: Fredrick
authors.initials: F
authors.lastname: Kummer
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rosen
authors.forename: Laith
authors.initials: L
authors.lastname: Jazrawi
mesh_terms: D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery; D001696:Biomechanical Phenomena; D001863:Bone Screws; D004868:Equipment Failure; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D020007:Implants, Experimental; D016268:Internal Fixators; D008422:Materials Testing; D011091:Polyesters; D013536:Suture Techniques; D013537:Sutures; D013718:Tensile Strength; D013978:Tibial Fractures / Q000601:surgery*
chemical_list: D011091:Polyesters