Tibial spine fractures: an analysis of outcome in surgically treated type III injuries.

We analysed the outcome of open reduction and internal fixation of type III tibial spine fractures, assessing treatment and determining a treatment pr otocol. A total of 10 patients presented over 3 years to our institution wi th a mean age of 15 years (range 10-21), a male-to-female ratio of 8:2. lef t to right 6:4 and anterior to posterior spine fracture 9:1. Only one patie nt had associated meniscal injury noted at arthroscopy (no treatment requir ed). The mode of injury was road traffic accidents four, sports injuries th ree and falls three. The mean follow-up was 9 months. There were seven excellent results and three good results. Those patients w ith good results exhibited either minimal quadriceps weakness, extensor lag (<10 degrees) or antero-posterior laxity. This reflects the experience of other authors in dealing with these injuries in younger patients. There is widespread agreement that types I and II should be treated by plaster cast alone and that is also the policy at our institution. We recommend a routine treatment protocol in type III injuries of (1) exami nation under anaesthesia, (2) arthroscopy (evaluating the fracture, cruciat e integrity and other associated injuries), (3) open reduction and screw fi xation and (4) vigorous physiotherapy/rehabilitation of all type III fractu res, as we feel this provides the best possible outcome in these injuries. (C) 1999 Elsevier Science Ltd. All rights reserved.