Tibial tubercle avulsion fracture - An original method of fragment fixation by K-Wires

Abstract

An original arthroscopic method of osteosynthesis for treatment of tibial tubercle avulsion is presented and documented on the histories of four patients. The avulsed portion of the tibial tubercle was fixed with two Kirschner wires bent intra-articularly to create hooks for fragment fixation. The K-wires were drilled with the use of a tibial aimer for anterior cruciate ligaments. A brace was applied for 1 to 6 weeks. The implants were removed at 8 to 13 weeks by arthroscopy. During their extraction carried out under anesthesia, one patient had a positive Lachmann test of 5 mm. All patients returned to preoperative activities. The mode of fixation reported here can also be useful for osteosynthesis at other sites. The method is minimally invasive, may also be employed in comminution and the implants are inexpensive. Compared to other methods, the main advantage of this one is that the hooks can be rotated inside the joint by the K-wire ends protruding outside. This permits correction of inaccurate insertion of K-wires, if it exists, without the necessity of repeated drilling. For this reason the method can be performed even by a less experienced arthroscopy surgeon. Removal of metal implants remains a disadvantage.