Pediatric Tibial Spine Fractures: Exploring Case Burden by Age and Sex

BACKGROUND: Pediatric tibial spine fractures (TSFs) are a well-known clinical entity, but the epidemiology of these injuries is not fully understood. Further, there is limited data on outcomes after TSF treatment, specifically the proportion of patients that go on to require subsequent ACL reconstruction after completing their initial treatment course. PURPOSE/HYPOTHESIS: To describe the distribution of TSF case burden by age and sex, and to determine the proportion of patients who undergo subsequent ACL reconstruction or develop ACL insufficiency. METHODS: The Truven Marketscan database was queried to identify patients aged 7-18 years with TSFs during the time period of 2016-2018. Diagnosis and initial treatment (surgical vs. nonoperative) was recorded based on database coding. Case burden by age and sex was calculated. The database, which includes longitudinal data, was then queried for subsequent diagnoses of ACL insufficiency as well as subsequent ACL reconstruction procedures performed among the subjects. RESULTS: We found 876 cases of TSF, 71.3% of which were treated nonoperatively. The male:female ratio for case burden was 2.2. Cases peaked at age 13-14 for males and age 11-12 for females (Figure 1). Of all cases identified, 3.7% also had either a diagnosis code for ACL laxity entered in a delayed fashion into the database or a later procedure code for ACL reconstruction (considered together to represent subsequent “ACL insufficiency”). Only 15 subsequent ACL reconstructions were found; all of which were among males, and 9 of which were among males 13-14 years old (Figure 2). CONCLUSION: This longitudinal study is the largest epidemiologic analysis of pediatric TSFs to date. We found low rates of subsequent ACL insufficiency and ACL reconstruction in general, with males aged 13-14 accounting for the most cases and exhibiting the highest rates of subsequent ACL insufficiency and ACL reconstruction. Rates of subsequent ACL reconstruction were lower than previously reported. Males accounted for about twice as many cases as females.