Purpose of the study: The purpose of this study was to detail therapeutic indications for fractures of the intercondylar eminence of the tibia with little displacement and preservation of the posterior hinge (type II fracture in the Zarincznyj classification).
Material and methods: We reviewed retrospectively a multicentric serie of type II fractures of the intercondylar eminence observed in children treated surgically. There were twenty patients, ten girls and ten boys, mean age 11.9 years (range 6-16). Imaging included plain x-rays of the knee (anteroposterior and lateral views) in all patients as well as computed tomography (5 patients) and magnetic resonance imaging (1 patient). Surgical treatment was performed in all cases, on average six days after trauma (range 0-25). A medial parapatellar arthrotomy was used in all cases. A non-resorbable thread was used for fixation associated with an anchor in the last four cases. Clinical and radiological assessment was reviewed at mean 3.7 years follow-up.
Results: All children had resumed their sports activities at the same level as before the accident within 4.8 months on average. None of the children suffered from an unstable knee or functional impairment at last follow-up. The Lysholm score was 88.9 on average (range 70-100) at three months postoperative and 99.2 (range 89-100) at last follow-up.
Discussion: There is currently agreement that non-displaced fractures of the anterior intercondylar eminence of the tibia should be treated orthopedically and that forms with displacement require surgery. Conversely, the type II fractures with an anterior gap but a preserved posterior hinge, the appropriate treatment remains a subject of debate. In our experience, surgery would appear to be preferable to orthopedic management. Surgery enables putting correct tension on the anterior crucicate ligament and limits the risk of residual laxity which, even though rarely associated with instability, could in the long-term lead to osteoathritic degradation or meniscal damage.
Conclusion: Surgical treatment of fractures of the intercondylar eminence of the tibia with little displacement and preservation of the posterior hinge provides satisfactory results and the best guarantee of long-term stability.