gms | German Medical Science

Objectives: The purpose of this study was to describe our arthroscopic suture fixation technique and Far anteromedial portal (FAM portal) for the tibial eminence fracture in children, and to report the short term result.

Methods: A 7-year-old girl twisted her left knee during recreational skiing.

Radiographs showed an avulsion fracture of the intercondylar eminence of the tibia that was type 3A fracture in the classification system of Meyers and McKeever.

She was treated with arthroscopy. Fracture visualization and a satisfactory reduction by releasing the medial meniscus were achieved by FAM portal. Three holes are drilled through the proximal tibia epiphysis. After 3 sutures are passed and centered, the sutures are drawn into the tibial holes and tied over a bone bridge.

Full weight bearing was allowed at 6 weeks postoperatively, and she was able to return to her previous level of activity at 6 months without the knee brace.

One year after surgery the patient had a stable, painless joint with a full range of motion.

Epiphyseal preservation is a critical issue in the treatment of pediatric intercondylar eminence fractures.

Although the pull-out method is advantageous for epiphyseal preservation, the steep angle makes operations with a soft wire difficult. While operations with sutures are relatively easy to perform, there is a concern regarding insufficient strength. We use 3 ETHIBOND sutures to increase the strength to approximately 200 N, which achieves sufficient fixing power for the lower limbs in children.

Conclusion: Use of the FAM portal makes it possible to employ the pull-out method, which requires no penetration into the epiphyseal plate, for intercondylar eminence fractures in children prior to epiphyseal closure. Sufficient fixing power can be achieved with the use of 3 sutures.