Arthroscopic cannulated screw fixation for nonunion after tibial eminence fracture in children

Objective To discuss arthmscopic treatment of nonunion after avulsed fracture of tibial intercondylar eminence in children.Methods From January 2003 to June 2008,we treated 11 pediatric cases of old avulsed fracture of tihial intercondylar eminence.Reduction of bone fragments was conducted arthroscopically.The tension of anterior cruciate ligament was recovered by slightly excessive debridement of the fracture ends.The bone fragments were fixed with 2 cannulated screws respectively.Results The 11patients were followed up from 12 to 42 months,with an average of 18 months.Slight limitation of knee extension was found in 3 cases,and at one year after operation limitation of knee flexion was found in 2 cases which responded to removal of internal fixation and arthroscopic lysis.The preoperative and postoperative Lachman and drawer tests were negative in all the 11 cases.The postoperative Ⅹ-ray showed that all fractures healed at one stage 3 months after operation.The average Lysbolm score was 73.51 ±6.38 before operation and98.32 ± 1.21 at the last follow-up(t = 15.165,P =0.000).The average International Knee Documentation Committee(IKDC)score was 71.15±5.51 before operation and 96.85±1.21 at the last follow-up(t=20.712,P = 0.000).Conclusions Arthroscopic treatment of nonunion after avulsed fracture of tibial intercondylar eminence in children has advantages of minimal trauma,simplicity and early rehabilitation.In addition,the cannulated screw internal fixation can provide stability and higher pressure to prevent nonunion. Key words: Tibial fractures; Fracture fixation,internal; Bone nails; Arthroscopy; Child