Fracture des épines tibiales chez l’enfant

Tibial spine fractures are rare lesions which usually occur in adolescent athletes aged between 8 and 17 years. The treatment of displaced fractures requires surgical reduction and fixation in order to achieve adequate tension in the anterior cruciate ligament and to reduce the risk of laxity. This study aimed to report our experience in the treatment of tibial spine fractures in children. We conducted a retrospective study of 11 children with tibial spine fractures over a period of 7 years (2009-2016). The average age of our patients was 13 years and a half. A fall during sport was the main cause of tibial spine fractures in 73% of patients. Meyers and Mac Keever classification, modified by Zaricznyj, was used and allowed to classify the lesions into 4 types. Two cases were orthopedically treated while 9 cases underwent surgical reduction through arthrotomy and fixation using osteosuture. After an average follow-up of 3 years our results were good in 91% of cases, according to Lysholm functional score. Only one case with orthopedically treated type II fracture still had a mean Lysholm functional score. Surgical treatment for types II-IV fractures (with the exception of type I) should be used in order to ensure a good anterior cruciate ligament tonus. The prognosis of tibial spine fractures is good. Surgical reduction should be used when tibial spine fractures are associated with displacement in order to better verify anterior cruciate ligament integrity and to ensure a good knee stability.