Fractures of the intercondylar eminence of the tibia

PURPOSE OF THE STUDY We analyzed a group of patients surgically treated for fractures of the intercondylar eminence of the tibia in the Department of Orthopedics in Pilsen between 1992 and 2002, and evaluated the results of this treatment on the basis of objective examination and comparison with the relevant literature data. We describe indications for surgical treatment and the surgical methods used, including different fixation materials. MATERIAL In the period from 1992 to 2002, 27 patients underwent surgery for a fracture of the intercondylar eminence of the tibia in our Department. The group included 19 men and 8 women aged between 8 and 49 years; the average age was 16.2 years. METHODS Surgery was indicated in type II and type III fractures of the intercondylar eminence of the tibia, as classified according to the Meyers and McKeveer system. Medial arthrotomy was used in 16 patients, nine of whom had undergone diagnostic arthroscopy. Arthroscopic surgery from the classical, either anterolateral or anteromedial, approach was performed in 11 patients. After arthroscope insertion, the knee joint was irrigated and inspected. The meniscus or transversal ligament, if interpositioned, were released and, subsequently, a dislocated fragment was reduced and fixed. Fixation was carried out with a Kirschner's wire, cannulated screw, wire loop or absorbable suture. RESULTS The patients were examined in 2003, after a follow-up ranging from 1 to 10 years. A total of 17 patients turned up. The outcome of treatment was evaluated on the basis of X-ray and clinical findings. Union of the eminence in an appropriate position was found on X-ray films in all patients. Clinical evaluation included the range of motion and knee joint stability. Restricted motion was found in three patients. No positive anterior drawer or Lachman's tests were recorded. DISCUSSION No failure of osteosynthesis was recorded in our patients although different fixation materials were used. This is in agreement with the results of other authors who did not report any failure of osteosynthesis due to insufficient stability provided by different fixation materials. The outcomes of surgical treatment in comparable patient groups were also similar. CONCLUSIONS Arthroscopy is considered the most suitable technique for the treatment of fractures of the intercondylar eminence of the tibia, because it is minimally invasive and provides a good view of the operative field. The outcome of surgery is not dependent on the fixation material used. However, metal implants, in contrast to absorbable materials, have to be removed in an additional surgical procedure.