Is Nonoperative Treatment Appropriate for All Patients With Type 1 Tibial Spine Fractures? A Multicenter Study of the Tibial Spine Research Interest Group.

Background

Type 1 tibial spine fractures are nondisplaced or ≤2 mm-displaced fractures of the tibial eminence and anterior cruciate ligament (ACL) insertion that are traditionally managed nonoperatively with immobilization.

Hypothesis

Type 1 fractures do not carry a significant risk of associated injuries and therefore do not require advanced imaging or additional interventions aside from immobilization.

Study Design

Case series; Level of evidence, 4.

Methods

We reviewed 52 patients who were classified by their treating institution with type 1 tibial spine fractures. Patients aged ≤18 years with pretreatment plain radiographs and ≤ 1 year of follow-up were included. Pretreatment imaging was reviewed by 4 authors to assess classification agreement among the treating institutions. Patients were categorized into 2 groups to ensure that outcomes represented classic type 1 fracture patterns. Any patient with universal agreement among the 4 authors that the fracture did not appear consistent with a type 1 classification were assigned to the type 1+ (T1+) group; all other patients were assigned to the true type 1 (TT1) group. We evaluated the rates of pretreatment imaging, concomitant injuries, and need for operative interventions as well as treatment outcomes overall and for each group independently.

Results

A total of 48 patients met inclusion criteria; 40 were in the TT1 group, while 8 were in the T1+ group, indicating less than universal agreement in the classification of these fractures. Overall, 12 (25%) underwent surgical treatment, and 12 (25%) had concomitant injuries. Also, 8 patients required additional surgical management including ACL reconstruction (n = 4), lateral meniscal repair (n = 2), lateral meniscectomy (n = 1), freeing an incarcerated medial meniscus (n = 1), and medial meniscectomy (n = 1).

Conclusion

The classification of type 1 fractures can be challenging. Contrary to prior thought, a substantial number of patients with these fractures (>20%) were found to have concomitant injuries. Overall, surgical management was performed in 25% of patients in our cohort.

Informations de copyright

© The Author(s) 2022.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: H.B.E. has received education payments from Pylant Medical; speaking fees from Pylant Medical, Smith & Nephew, and Synthes; and hospitality payments from Arthrex. P.D.F. has received hospitality payments from Medical Device Business Services. T.J.G. has received education payments from Arthrex. I.K. has received education payments from Arthrex and Smith & Nephew and hospitality payments from DePuy Synthes. R.J.L. has received education payments from Arthrex and hospitality payments from Vericel. S.M. has received education payments from MedInc of Texas. T.A.M. has received education payments from Arthrex and consulting fees from Medtronic, OrthoPediatrics, and Zimmer Biomet. N.M.P. has received education payments from Liberty Surgical and Medwest and speaking fees from Arthrex. J.R. has received research support from Smith & Nephew and consulting fees from OrthoPediatrics. B.S. has received education payments from MidSouth Orthopedics. Y.-M.Y. has received consulting fees from Smith & Nephew and hospitality payments from Kairos Surgical. G.A.S. has received education payments from Arthrex and speaking fees from SIGN. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.