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Operative repair of a tibial spine fracture in a 3-year-old: a case report

INTRODUCTION Tibial spine fractures are injuries typically observed in the pediatric population. Most of these fractures occur in patients 8 to 14 yr of age. Studies have reported that up to 80% of these injuries are seen in patients younger than 11 yr old. Because of the immature nature of pediatric bone, a strong force causing high tension in the anterior cruciate ligament (ACL) can place a large stress on its insertion site at the tibial spine and result in a fracture. Mechanisms that lead to tibial spine fractures are similar to those that cause ACL injuries in skeletally mature patients, namely rotational forces and hyperextension. The diagnosis of tibial spine fracture is made with history, physical examination, and imaging. In younger patients, plain radiographs may not be able to discern a tibial spine fracture if it is only involving cartilaginous structures; therefore, MRI may be helpful if there is a high index of suspicion. Treatment depends on the type of fracture, which has been organized into three categories by Meyers and McKeever. Although there is no definitive protocol for the treatment of tibial spine fractures, it is widely understood that nonreducible, displaced or comminuted fractures, and Meyers’ type III, IV, and certain type IIs, require operative management. There are multiple approaches to surgical repair including open or arthroscopic reduction with screw or suture fixation. The case presented here is the operative repair of a tibial spine fracture in a 3-year-old patient. To the authors’ knowledge, this is by far the youngest patient reported in the literature with this injury. The fracture was treated successfully with arthroscopic reduction and fixation with bioabsorbable, barbed implants. The authors demonstrated that surgical repair is a viable option in the treatment of tibial spine fractures in patients as young as 3. The authors believe this case can serve as a source of guidance for the management of tibial spine fractures in extremely young patients. Informed consent was obtained from the patient’s mother regarding the use of medical information for research purposes. Institutional review board approval was not required for this case report.