Abstract
Authors in the presentation document the arthroscopic method of treatment of tibial intercondylar eminence fractures in children age. They follow up the short-time and middle-time results after using this method in 20 patients.
Method consists in early arthroscopic revision of traumatized knee joint in children with avulsion of intercondylar eminence, haematoma irrigation and the management of the eminence avulsion depending on the size of the tibial bone fragment. Because of bleeding and fat release from traumatized bone is recommended using the water pressure pump. The reposition of the bone fragment to the original position is made after the fracture bed revision and inverted soft tissues removal. The reposition is recommended to do in 30 grade flection of the knee when LCA is maximally relaxed and fragment retention is optimal. After the reposition of the bone fragment we fix it by 2 crossed Ki wires inserted or percutaneously parapatellarly or by the arthroscopic portal using method outside-inside-out.. Immobilization is recommended in 30 grade flection position.
The evaluation of 20 patients after arthroscopic surgery shows on the x-ray excellent and very good results in all patients. In 16 cases the clinical examination result is excellent with no instability of the knee, stable LCA and no front shift sign. In 4 cases was found front shift sign without clinically significant anteromedial stress instability of the knee. In 1 case there was made conversion to open revision with suturing of the fragment by PDS suture. Because the bony fragment was 1cm2 large only the closed reposition and retention was not sufficient.
The method appears certainly gentle with minimal traumatization of the joint capsule. The above all advantage is in non traumatic metals replacement without second stage surgery and anesthesia. In 4 cases we saw temporary LCA hyperlaxity. We prerequisite passive tonization of the ligament while skeleton growth. Clinical results of the method are satisfactory comparable to the open reduction and fixation by suture or cerclage. The method is not recommended in cases with bony fragment smaller then 1cm2 for not sufficient retention. In these cases we do an arthroscopic verification followed by open reduction.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
