![]() ![]() They concluded that 2 single-armed #2 Ethibond sutures, 3 bio absorbable nails, a single resorbable screw, or a single metal screw do not have any significant mechanical advantage over other. Biomechanical comparison of 4 different methods of fixation was done by Mahar and collegues on immature bovine knees. ![]() Bong and coworkers in their biomechanical comparative study of screw versus fibrewire fixation concluded that fibrewire fixation was significantly stronger than cannulated screw fixation. Seon and Park did a clinical comparative study of screw fixation and suture fixation method for tibial spine avulsion fractures and concluded that there is no significant clinical difference in terms of clinical outcome and stability. There are only few comparative studies in literature to recommend which is the best technique of fixation for these fractures. Various methods of fixation are used in operative treatment of these fractures varying from retrograde wires /screws, antegrade screws ,sutures ,suture anchors, and a recently described suture bridge and K wire and tension band wiring technique. Treatment of displaced tibial spine avulsion fractures has evolved over a period of time from conservative management to open reduction and internal fixation to arthroscopic reduction and internal fixation. It has also been proposed that injury occurs secondary to greater elasticity of ligaments in young people. The cause of increased incidence amongst children is hypothesized as being secondary to relative weakness of incompletely ossified tibial eminence compared to native ACL fibres. In adults these injuries are commonly related to high energy trauma usually road traffic accidents and have high incidence of associated injuries. These injuries are commonly seen in children aged between 8-13 years and are usually sports related injuries occurring especially during cycling and skiing. Poncet in 1895 was probably the first person to document these types of injuries and it was only in 1959 that Meyers and McKeever described an account of surgical management of type II injuries of tibial spine. They represent a variant of anterior cruciate ligament injury. These fractures are also called as tibial eminence fractures or ACL avulsion fractures. Avulsion fractures of tibial spine, leading to discontinuity of anterior cruciate ligament fibers has been well described in literature in both pediatric and adult population. ![]()
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