Author/Editor		Senekovič, Vladimir; Balažic, Matej
Title		Bioabsorbable sutures versus screw fixation of displaced tibial eminence fractures
Type		članek
Vol. and No.		Letnik 24, št. 2
Publication year		2014
Volume		str. 209-216
ISSN		1633-8065 - European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Language		eng
Abstract		Background In 1995, we developed a simple and safe arthroscopic technique of anterograde stable fixation of the displaced tibial eminence fractures using a cannulated screw and washer, allowing immediate mobilisation and weight bearing. Some authors described similar end results by arthroscopic fixation of this abruption with trans-osseous sutures. We proved with the biomechanical study that the fixation with strong trans-osseous sutures provides a comparable stable fixation the same as the cannulated screw and washer. We developed a test machine for cyclic loading and a machine for measuring of the pull-out strength for this study. Methods A standard osteotomy of the tibial spine was performed during the cadaveric biomechanical study. We performed an arthroscopic fixation with the cannulated screw and washer in ten knees, and in another group of ten knees, arthroscopic fixation was made using two trans-osseous Orthocord sutures. The operating time for each procedure was measured, and any possible technical complications were recorded. One thousand cycles of flexion from 0⁰ to 90⁰ were performed on a special loading device on all knees. The macroscopic dislocation of the fragment was measured. After the cyclic loading, all soft tissue was resected except the anterior cruciate ligament with the fixed fragment. The pull-out strength defined as translation of the tibia in anterior direction by breakage was measured with a custom-made measuring device. Results The average time for the screw and washer fixation was 20 min, and average time for the sutures fixation was 48 min. After cyclic loading, we did not see any dislocation of the fragment. Average pull-out strength at which fixation with a cannulated screw and washer fell was 253.42 N and mean pull-out strength at which fixation with trans-osseous sutures fell was 330.32 N. Fixation of the fragment with trans-osseous sutures was statistically significantly stronger-Wilcoxon-Mann-Whitney's test, p = <0.00. Conclusion Fixation with strong trans-osseous sutures is stronger than fixation with a cannulated screw and washer on cadaveric knees. It appears that fixation with strong trans-osseous sutures allows immediate mobilisation and weight bearing like fixation with a cannulated screw and washer. Meanwhile, the time for fixation with trans-osseous sutures is significantly longer.
Keywords		zlom tibialne eminence transoblacioni šivi fiksiranje vijakov tibial eminence fractures trans-osseous sutures screw fixation