Lower Extremity Avulsion Fractures in the Pediatric and Adolescent Athlete.

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Abstract

[Indexed for MEDLINE] 8. Orthopade. 2014 Apr;43(4):393-401: quiz 402-3. doi: 10.1007/s00132-014-2290-6. [Pediatric knee injuries]. [Article in German] Schneider F(1), Sperl M, Steinwender G, Kraus T. Author information: (1)Abteilung für Kinderorthopädie, Universitätsklinik für Kinderchirurgie, Medizinische Universität Graz, Auenbruggerplatz 34, 8036, Graz, Österreich, frank.schneider@klinikum-graz.at. Patella dislocations are the most common knee injuries causing hemarthrosis in children. Flake fractures represent the main complication of these injuries and require fixation. First time dislocations are treated conservatively. Recurrent dislocations are managed operatively. Precise analysis of the underlying dispositional and pathological factors is important to determine the appropriate operative procedure. To protect the growth plate, special techniques are required. Tibial spine fractures are bony avulsions of the anterior cruciate ligament (ACL). Management includes closed reduction in hyperextension and immobilization in a knee cast. Tibial spine fractures which cannot be reduced require operative treatment using either arthroscopic or open reduction and stabilization without injuring the growth plate. Intraligamentous ACL injuries are increasingly observed in children and adolescents. The risk of meniscus tears or chondral damage is high in these injuries. In case of persistent ACL instability, early reconstruction is recommended. Various techniques have been described; however, there is no consensus regarding the most favorable technique. The attending physician must be familiar with different ACL reconstruction techniques and with the anatomy of the growth plate. Meniscus tears require early suturing. Healing rates are good in children. DOI: 10.1007/s00132-014-2290-6