Tibial spine fractures: a long-term follow-up study of open reduction and internal fixation

OBJECTIVE: To analyze the long-term (5-27 years) functional and radiologic results of surgically treated tibial spine fractures. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENTS AND METHODS: Forty-four surgically treated consecutive patients with 44 displaced tibial spine fractures were included in this study. All fractures were classified according to a modified Meyers and McKeever classification. There were 24 men and 20 women. The mean age at time of accident was 24 years (range 9-57 years). Sixteen patients had an open physis at the time of trauma. There were 36 patients with isolated fractures and 8 with multiple fractures. All patients were seen for a 1-year follow-up, and 37 patients (84%) were seen for a long-term follow-up visit. Functional results of these 37 patients were graded using the Lysholm, SF-36, and the Western Ontario and McMaster Universities scores. Radiologic results were graded using the Ahlbäck score. RESULTS: At 1-year follow-up, in all 44 patients, the fracture was fully healed. One patient (3%) needed revision of the osteosynthesis due to hardware failure, and in 1 patient (3%), a deep infection (purulent arthritis) developed that was treated by surgical irrigation. The median knee range of motion (ROM) after 1 year was 125 degrees (range 110-140 degrees). The ROM did not change significantly at long term. After a mean follow-up of 16 years (range 5-27 years), the median knee ROM was 130 degrees (range 115-140 degrees). As measured with an objective testing device, no statistically significant difference of anteroposterior stability between the injured and uninjured legs was found, with a mean difference of 1 mm (range -3.9 to 6.9 mm). The Lysholm score showed good to excellent results in 86% of the patients; the Western Ontario and McMaster Universities score showed a mean of 93 (range 40.63-100) points. The mean SF-36 general health score was 77 (24-99). The Ahlbäck score showed a moderate development of secondary osteoarthritis in 2 of the 37 patients (5%). The 16 patients with an open physis at the time of the operation did not develop axial malalignment at long term. CONCLUSIONS: Surgical treatment of tibial spine fractures offers the possibility to regain full stability of the knee joint and good long-term results after open reduction and internal fixation with low infection rates. Knee function is adequately restored in most patients with a minimal risk of developing secondary osteoarthritis