Arthroscopic repair for displaced tibial fracture possible with all-inside device

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Arthroscopic repair of displaced tibial spine fractures in children and adolescents using an all-inside device yielded excellent results and did not require a second procedure for hardware removal, according to Dutch investigators.

Diederick B. Wouters, MD, and colleagues from The Netherlands studied a prospective, consecutive series in which orthopedic surgeons arthroscopically repaired 12 tibial spine fractures in 11 children with Meniscus Arrows (ConMed) after fracture reduction. The four boys and seven girls included in the study had an average age of 12 years. After surgery, the patients were immobilized in plaster of Paris for 5 weeks.

Postoperatively, the investigators obtained radiographs, Lachmann tests on all patients and KT-1000 tests on eight of the 12 knees. The average follow-up was 4 years.

All of the fractures united, and all of the patients returned to their previous activity level without restrictions, the authors wrote. Lachmann test results showed that two knees had mild anterior-posterior laxity; however, this increased laxity did not affect function. The KT-1000 tests showed revealed a maximum difference in laxity of 3 mm in the first patient, 2 mm in the second patient and between 1. 5 mm and -0.1 mm in the remaining patients.

“The smaller diameter, compared to the SmartNail [ConMed Linvatech], makes the Meniscus Arrow arguably the more preferred device for this indication,” the authors wrote. “Accurate reduction before fixation can improve the results.”

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