title: Management of a rare complication after screw fixation of a pediatric tibial spine avulsion fracture: a case report with follow-up to skeletal maturity.
abstract: Avulsion of the tibial spine is functionally equivalent to rupture of the anterior cruciate ligament in an adolescent athlete. It therefore presents to general orthopaedists as well as a wide variety of orthopaedic subspecialty surgeons, including traumatology sports medicine, and pediatrics. Restoration of normal knee kinematics is dependent on anatomic reduction and fixation of the avulsed fragment. Because this injury is typically sustained by the skeletally immature patient, epiphyseal fixation is ideal to avoid physeal injury, which can lead to angular limb deformity. We present a case, the first report to our knowledge, of coronal plane deformity in a lower extremity after open reduction and internal fixation of a tibial spine avulsion fracture. A successful treatment plan using hemiepiphysiodesis and guided growth is used with 20-month follow-up to skeletal maturity.
authors.affiliation: Hospital for Special Surgery, New York, NY 10021, USA. fabricantp@hss.edu
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.forename: Daryl C
authors.initials: DC
authors.lastname: Osbahr
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Green
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D001846:Bone Development / Q000502:physiology*; D017760:Bone Malalignment / Q000503:physiopathology / Q000601:surgery*; D001863:Bone Screws; D004838:Epiphyses / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006132:Growth Plate; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D011475:Prosthesis Failure; D020127:Recovery of Function; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome