Anterior displacement of tibial spine fractures, does anatomic reduction matter

Young patients who undergo surgery for displaced tibial spine fractures and who had both an extension and flexion contracture, had 2.2 times the odds of having a complication compared to patients who did not have any contractures, according to research presented today at the American Orthopaedic Society for Sports Medicine's 2022 Annual Meeting.

To investigate this further researchers determined if residual displacement of the anterior portion of a tibial spine fragment affects the range of motion or laxity in post-operative and non-operatively treated tibial spine patients and to assess if anterior lip displacement (ALD) predicts complications in these patients.

A total of 578 patients treated for tibial spine fractures from an institutional review board-approved multicenter retrospective cohort of patients treated for tibial spine fractures between January 1, 2000, and January 31, 2019, at 10 institutions.

The researchers examined range of motion and anterior lip displacement measurements and compared these from pre-treatment to the patient's final visit. Anterior lip displacement measurements were categorized into four groups: 0 to <1 mm, excellent; 1 to <3 mm, good; 3 to 5mm, fair; and >5mm, poor.

Of the 578 patients reviewed, 82 % (474/578) had an operative treatment while only 18% of patients (104/578) had a non-operative treatment. There was a higher proportion of patients who had a positive Lachman test in the non-operative group (12%; 12/104) compared to the operative group (4%; 18/474; p=0.001). The surgical group had a median time of 3.4 months from surgery (range, 0.10 to 91.86 months) to final displacement measurement, while the non-operative group had a median time of 2.6 months from initial treatment to final displacement measurement (range, 0.07 to 61.37 months).

Operative patients who had both an extension and flexion contracture had 2.2 times the odds of having a complication compared to patients who did not have any contractures, this was independent of final ALD, ended the researchers.

Reference: "Anterior displacement of tibial spine fractures, does anatomic reduction matter?"AMERICAN ORTHOPAEDIC SOCIETY FOR SPORTS MEDICINE