|Beitragstitel||Fixation of an intercondylar eminentia fracture in the child with a hock shaped Kirschner wire minimal invasive|
Intercondylar fractures of infantile patients are not frequently. The operative technic can be difficult for the untrained surgeon. In most cases the injury is presented in an avulsion fracture on the tibial insertion with the classification of Meyer and McKeever type II.
We try to explain a simple method with standard surgical treatment for the reconstruction of the ACL.
We use standard anteromedial and anterolateral arthroscopic portals to reduce the fracture. In most cases the medial meniscus resists repositioning. Without need of resection of the intermeniscal ligament we reposition the fracture with a small arthroscopic hook and hold it in position.
A small incision is made on the medial side of the tibia metaphysis and the tibial aimimg device for the standard ACL reconstruction is positioned through the medial arthroscopic portal and reduce the fracturer. Over this aming device you can bring in a 1mm k-wirer. With a standard needle holder over the anterolateral portal bend the k-wire 180° intraarticular and push it distal to fix it in the fragment. The metaphyseal fixation is made with a standard 3,5mm AO screw. Postoperative Care with a Fixed brace for 6 weeks.
After consolidation you can remove the screw and the Kirschner wire under short anesthesia and incision on the metaphysis without opening the joint.
In our Patients we found no loss of reduction. After 6 Weeks in a fixed brace we started to mobilize the knee without a limit. All patients returned to the previous activity level and there was no clinical relevant instability of the knee.
We see the advantages of the described method above in the technically less demanding execution as well as in the gentle and only minimally invasive technique. The physeal growth plate, which is only bridged by a 1.0 mm Kirschner wire, is significantly less damaged than by the osteosynthesis with screws.