Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Volume 8 | Issue 2 | May-August 2022 | Page: 20-23 | Anil Agarwal, Ankit Jain, Ravi Jethwa, Jatin Raj Sareen

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.139

Authors: Anil Agarwal MS Ortho [1], Ankit Jain D Ortho [1], Ravi Jethwa MS Ortho [1], Jatin Raj Sareen MS Ortho [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Address of Correspondence

Dr. Anil Agarwal
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
E-mail: rachna_anila@yahoo.co.in

Abstract

Skeletal dysplasia in children is sometimes associated with severe coronal plane angulations around the knee. The associated ligament laxity adds to the complexity of surgical correction. Osteotomies require precise surgical planning and execution. Hemiepiphyseodesis is usually employed only in mild and moderate deformity. Distraction osteogenesis method is labour intensive, costly and requires a prolonged treatment course. We describe an innovative surgical technique which combines hemiepiphysiodesis using tension-band plates and a metaphyseal osteotomy. The technique utilises acute bony correction by osteotomy followed by residual correction, if any and soft tissue fine tuning through growth modulation. Growth modulation also addresses recurrence to some extent. The surgical technique is described along with illustrative case examples.
Keywords: Skeletal dysplasia, Osteotomy, Hemiepiphyseodesis

References

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2. Rosskopf AB, Buck FM, Pfirrmann CW, Ramseier LE. Femoral and tibial torsion measurements in children and adolescents: comparison of MRI and 3D models based on low-dose biplanar radiographs. Skeletal Radiol. 2017;46:469-476.
3. Thacker MM, Davis ED, Ditro CP, Mackenzie W. Limb lengthening and deformity correction in patients with skeletal dysplasias. In: Sabharwal S (eds.). Pediatric Lower Limb Deformities. Springer, Cham; 2016. doi: 10.1007/978-3-319-17097-8_19
4. Bell DF, Boyer MI, Armstrong PF. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. J Pediatr Orthop. 1992;12:283-290. doi: 10.1097/01241398-199205000-00003
5. Pinkowski JL, Weiner DS. Complications in proximal tibial osteotomies in children with presentation of technique. J Pediatr Orthop. 1995;15:307-312.
6. Yilmaz G, Oto M, Thabet AM, Rogers KJ, Anticevic D, Thacker MM, Mackenzie WG. Correction of lower extremity angular deformities in skeletal dysplasia with hemiepiphysiodesis: a preliminary report. J Pediatr Orthop. 2014;34:336-345. doi: 10.1097/BPO.0000000000000089
7. Cho TJ, Choi IH, Chung CY, Yoo WJ, Park MS, Lee DY. Hemiepiphyseal stapling for angular deformity correction around the knee joint in children with multiple epiphyseal dysplasia. J Pediatr Orthop. 2009;29:52-56.
8. Shabtai L, Herzenberg JE. Limits of growth modulation using tension band plates in the lower extremities. J Am Acad Orthop Surg. 2016;24):691-701. doi: 10.5435/JAAOS-D-14-00234
9. Masquijo JJ, Artigas C, de Pablos J. Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use. EFORT Open Rev. 2021;6:658-668. doi: 10.1302/2058-5241.6.200098
10. Bell DF, Boyer MI, Armstrong PF. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. J Pediatr Orthop. 1992;12:283-290.
11. Myers GJ, Bache CE, Bradish CF. Use of distraction osteogenesis techniques in skeletal dysplasias. J Pediatr Orthop. 2003;23:41-45.

How to Cite this Article: K Agarwal A, Jain A, Jethwa R, Sareen JR |  Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique | International Journal of Paediatric Orthopaedics | May- August 2022; 8(2): 20-23.
https://doi.org/10.13107/ijpo.2022.v08i02.139

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Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

Volume 8 | Issue 2 | May-August 2022 | Page: 11-15 | K Venkatadass, V Durga Prasad, Deepak Jain, S Rajasekaran

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.138

Authors: K Venkatadass MS Orth [1], V Durga Prasad D Orth [1], Deepak Jain MS Orth [1], S Rajasekaran MS Orth [1]

[1] Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. K Venkatadass,
Consultant & Head of Paediatric Orthopaedics, Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: venkatpedortho@gmail.com

Abstract

Concomitant tibia shaft and ipsilateral triplane fracture in the paediatric population is a known but uncommon presentation. After the first report in 2001, approximately 27 cases have been reported to date. We aimed to do a comprehensive literature review and to present our experience with these rare fractures. We report three such cases of distal-third spiral tibial fractures with three-part triplane fracture. The average age was 15.3 years. The average Body mass index was 31.3 kg/m2. Two patients underwent rigid intramedullary locking nail for shaft fractures, and one patient underwent Ender’s nailing. All triplane fractures were fixed with percutaneous screws. There were no intraoperative or postoperative complications. The average union time was 10.6 weeks. We highlight the patient and injury characteristics in these fractures. A high index of suspicion of an associated ankle fracture is needed in obese adolescents presenting with distal-third tibia fractures. Tibia fractures demand rigid internal fixation whenever possible due to associated obesity.
Keywords: Concomitant, Ipsilateral, Triplane, Tibia, Shaft, Ankle Fracture, Obesity

References

1. Kempegowda H, Maniar HH, Richard R, et al. (2016) Posterior Malleolar Fractures Associated with Tibial Shaft Fractures and Sequence of Fixation. J Orthop Trauma, 30(10):568-571.
2. Jarvis JG, Miyanji F. (2001) The Complex Triplane Fracture: Ipsilateral Tibial Shaft and Distal Triplane Fracture: The Journal of Trauma: Injury, Infection, and Critical Care, 51(4):714-716.
3. Holland TS, Prior CP, Walton RD. (2018) Distal tibial triplane fracture with ipsilateral tibial shaft fracture: A case series. Surgeon, 16(6):333-338.
4. Kasture S, Azurza K. (2017) Triplane Ankle Fracture with Concomitant Ipsilateral Shaft of Tibia Fracture: Case Report and Review of Literature. Journal of Orthopaedic Case Reports, 7(3):4.
5. Sprenger De Rover WB, Alazzawi S, Hallam PJ, Walton NP. (2011) Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report. J Orthop Surg (Hong Kong), 19(3):364-6.
6. Sferopoulos NK. (2018) Concomitant tibia shaft and triplane fractures. International Journal of Radiology, 5(1):197-201.
7. Sheffer BW, Villarreal ED, Iii MGO, Sawyer JR, Spence DD, Kelly DM. (2019) Concurrent Ipsilateral Tibial Shaft and Distal Tibial Fractures in Pediatric Patients: Risk Factors, Frequency, and Risk of Missed Diagnosis. J Pediatr Orthop., 40(1):5.
8. Durga Prasad V, Sangeet G, Venkatadass K, Rajasekaran S. (2021) Ender’s nailing of displaced tibia shaft fractures in children – A nine-year experience. Injury, 52(4):837-843.
9. Rogers GP, Tan HB, Foster P, Harwood P. (2019) Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method. Strategies Trauma Limb Reconstr., 14(1):20-24.
10. Rico-Pecero J, Dwyer A. (2009) Triplane fracture of the ankle associated with homolateral tibial fracture in a teenager. A case report. Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 53(4):254-256.
11. Stuermer EK, Stuermer KM. (2008) Tibial shaft fracture and ankle joint injury. J Orthop Trauma, 22(2):107-112.
12. Ertl JP, Barrack RL, Alexander AH, Van Buecken K. Triplane fracture of the distal tibial epiphysis. Long-term follow-up. J Bone Joint Surg Am. 1988 Aug;70(7):967-76. PMID: 3403587.
13. Lurie, B., Van Rysselberghe, N., Pennock, A. T., & Upasani, V. V. (2020). Functional outcomes of tillaux and triplane fractures with 2 to 5 millimetres of intra-articular gap. Journal of Bone and Joint Surgery, 102(8), 679–686.
14. El-Karef E, Sadek HI, Nairn DS, Aldam CH, Allen PW. Triplane fracture of the distal tibia. Injury. 2000 Nov;31(9):729-36. Doi: 10.1016/s0020-1383(00)00086-3. PMID: 11084162.

How to Cite this Article: K Venkatadass, V Durga Prasad, Jain D, S Rajasekaran | Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series With Comprehensive Review Of Literature | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 11-15.
https://doi.org/10.13107/ijpo.2022.v08i02.138

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Overcorrection as Complication of Growth Modulation with Eight-Plate for Coronal Plane Deformities of Knee and its Management

Volume 8 | Issue 2 | May-August 2022 | Page: 06-10 | Sandeep Patwardhan, Arkesh Madegowda, Sujith Omkaram, Pavan Patil, Ashok Shyam, Parag Sancheti

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.137

Authors: Sandeep Patwardhan MS Ortho [1], Arkesh Madegowda MS Ortho [1], Sujith Omkaram MS Ortho [1], Pavan Patil MS Ortho [1], Ashok Shyam MS Ortho [1], Parag Sancheti MS Ortho [1]

[1] Department of Paediatric Orthopaedics Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence
Dr. Arkesh Madegowda,
Clinical Fellow, Department of Paediatric Orthopaedics Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: dr.arkesh@gmail.com

Abstract

Objectives: To report the incidence of overcorrection as complication following eight-plate application for genu varum/valgum deformities and its management.
Methods: This was a retrospective review of children who underwent growth modulation for genu varum/valgum between 2012-2019. Data of patients who had presented with overcorrection of their primary deformity, the reasons for such complication and its management were collected and analysed.
Results: 110 children had undergone growth modulation during the study period. 75 children (68%) had achieved deformity correction in mean time of 14.4 months and had their implant removed on time when intercondylar (ICD)/intermalleolar (IMD) distance was ≤ 5 centimeters (cms) and/or Hip Knee Ankle (HKA) angle was < ±6⁰. 29 children (26%) were lost to follow up. 6 children (5.4%) had presented with overcorrection of moderate to severe grade with mean ICD/IMD of 13.3 cms (range 11-18) and mean HKA angle of 14.3⁰ (range 11-21⁰). Mean age of initial surgery was 6.1 years (range 5-8). Mean time gap of presentation with overcorrection was 33.6 months (range 24-45). Lack of awareness, long distance of hospital, medical expenses were some of the notable reasons for irregular follow-up. All 6 had an open physes with growth remaining when they presented with overcorrection. These children managed with repeat growth modulation. Final correction was achieved at mean time of 15.3 months and underwent implant removal. At the latest follow up of 4.4 years, limb alignment within physiologic limits was maintained.
Conclusion: Children undergoing growth modulation should be carefully monitored with regular follow-up to avoid complication of overcorrection. Overcorrection beyond physiologic limits can be managed with repeat growth modulation in younger children with open physes.
Keywords: Growth modulation, Genu valgum, Genu varum, Irregular follow up, Complication, Overcorrection.

References

1. Saran N, Rathjen KE. Guided growth for the correction of pediatric lower limb angular deformity. J Am Acad Orthop Surg. 2010 Sep;18(9):528-36.
2. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate. J Pediatr Orthop. 2007 Apr-May;27(3):253-9.
3. Danino B, Rödl R, Herzenberg JE, Shabtai L, Grill F, Narayanan U, Segev E, Wientroub S. Guided growth: preliminary results of a multinational study of 967 physes in 537 patients. J Child Orthop. 2018 Feb 1;12(1):91-96. doi: 10.1302/1863-2548.12.170050.
4. Radtke K, Goede F, Schweidtmann K, Schwamberger T, Calliess T, Fregien B, Stukenborg-Colsman C, Ettinger M. Temporary hemiepiphysiodesis for correcting idiopathic and pathologic deformities of the knee: A retrospective analysis of 355 cases. Knee. 2020 Jun;27(3):723-730.
5. Kumar S, Sonanis SV. Growth modulation for coronal deformity correction by using Eight Plates-Systematic review. J Orthop. 2018 Feb 2;15(1):168-172
6. Kemppainen JW, Hood KA, Roocroft JH, Schlechter JA, Edmonds EW. Incomplete Follow-up After Growth Modulation Surgery: Incidence and Associated Complications. J Pediatr Orthop. 2016 Jul-Aug;36(5):516-20.
7. Zajonz D, Schumann E, Wojan M, Kübler FB, Josten C, Bühligen U, Heyde CE. Treatment of genu valgum in children by means of temporary hemiepiphysiodesis using eight-plates: short-term findings. BMC Musculoskelet Disord. 2017 Nov 15;18(1):456.
8. Lawing C, Margalit A, Ukwuani G, Sponseller PD. Predicting Late Follow-up and Understanding Its Consequences in Growth Modulation for Pediatric Lower Limb Deformities. J Pediatr Orthop. 2019 Jul;39(6):295-301.
9. Gupta P, Gupta V, Patil B, Verma V. Angular deformities of lower limb in children: Correction for whom, when and how? J Clin Orthop Trauma. 2020 Mar-Apr;11(2):196-201.
10. De Brauwer V, Moens P. Temporary hemiepiphysiodesis for idiopathic genua valga in adolescents: percutaneous transphyseal screws (PETS) versus stapling. J Pediatr Orthop. 2008 Jul-Aug;28(5):549-54.
11. Degreef I, Moens P, Fabry G. Temporary epiphysiodesis with Blount stapling for treatment of idiopathic genua valga in children. Acta Orthop Belg. 2003;69(5):426Y432.
12. Heath CH, Staheli LT. Normal limits of knee angle in white children–genu varum and genu valgum. J Pediatr Orthop. Mar-Apr 1993.
13. Saini UC, Bali K, Sheth B, Gahlot N, Gahlot A. Normal development of the knee angle in healthy Indian children: a clinical study of 215 children. J Child Orthop. 2010 Dec;4(6):579-86.
14. Masquijo JJ, Artigas C, de Pablos J. Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use. EFORT Open Rev. 2021 Aug 10;6(8):658-668.
15. Chang FM, Ma J, Pan Z, Hoversten L, Novais EN. Rate of correction and recurrence of ankle valgus in children using a Transphyseal medial malleolar screw. J Pediatr Orthop. 2015;35:589–592.
16. Vaishya R, Shah M, Agarwal AK, Vijay V. Growth modulation by hemi epiphysiodesis using eight-plate in Genu valgum in Paediatric population. J Clin Orthop Trauma. 2018 Oct-Dec;9(4):327-333.

How to Cite this Article:  Patwardhan S, Madegowda A, Omkaram S, Patil P, Shyam A, Sancheti P | Overcorrection as Complication of Growth Modulation with Eight-Plate for Coronal Plane Deformities of Knee and its Management | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 06-10.
https://doi.org/10.13107/ijpo.2022.v08i02.137

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Modified Woodward’s Procedure in the Management of Neglected Sprengel’s Shoulder

Volume 8 | Issue 2 | May-August 2022 | Page: 02-05 | Tushar Nayak, Amrut Raje, Ashish Ragase, Love Kapoor , Venkatesan Sampath Kumar, Shah Alam Khan

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.136

Authors: Tushar Nayak MS Ortho [1], Amrut Raje MS Ortho [2], Ashish Ragase MS Ortho [2], Love Kapoor MS Ortho [3], Venkatesan Sampath Kumar MS Ortho [1], Shah Alam Khan MS Ortho [1]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
[2][ Department of Musculoskeletal Oncology, All India Institute of Medical Sciences, New Delhi, India.
[3] Department of Orthopaedics, N.C.I.; A.I.I.M.S, Jhajjar, Haryana, India.

Address of Correspondence
Dr. Tushar Nayak,
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
E-mail: orthodrtushar@gmail.com

Abstract

Introduction: With a less than ideal health infrastructure and a vast underprivileged population in our country, many cases of Sprengel’s deformity are initially missed and are subsequently untreated. Although for best surgical results, the patient must be under the age of five, many patients present late at out tertiary care center. Thus, we evaluated the clinical results of the modified Woodward’s Procedure in such neglected cases.
Methods: A retrospective study, of 16 patients aged 8-yr or above, with Sprengel’s deformity who underwent the modified Woodward’s procedure between 2006 and 2011. Clavicular osteotomy/morselization was avoided. The Cavendish scoring system was used to grade cosmesis and shoulder abduction was used to assess the functional outcome. The patients were prospectively followed up at two-years and after skeletal maturity.
Results: There were ten females and six males and the average age was 9.4 years. The mean follow up was 4.2 yr. Omo- vertebral bar excision was done in 13 (81.25%) patients. The mean increase in postoperative shoulder abduction and Cavendish grades at a 2-yr follow-up were, 19.1° and 1.32 grades, respectively. None of our patients needed Clavicular osteotomy/morselisation and none developed neurological abnormalities. The was no change in the values at skeletal maturity.
Conclusion: Satisfactory outcomes can be acquired by the Modified Woodward’s procedure in neglected Sprengel’s deformities. Besides a definitive cosmetic correction, the procedure also results in improvement of shoulder abduction. Clavicular Ostetomy/Morselization is not always required in cases presenting after the age of 8 years.
Keywords: Woodward’s procedure; Sprengel’s shoulder, Cavendish grading, modified Woodward’s procedure; neglected Sprengel deformity.

References

1. Woodward JW. Congenital elevation of the scapula: Correction by release and transplantation of muscle origins. JBJS. 1961;43(2):219–28.
2. Erken EHW, Barrow MS, Aden AA. CONGENITAL ELEVATION OF THE SCAPULA–SPRENGEL’S DEFORMITY. In: Orthopaedic Proceedings. The British Editorial Society of Bone & Joint Surgery; 2002. p. 79-f.
3. Khairouni A, Bensahel H, Csukonyi Z, Desgrippes Y, Pennecot GF. Congenital high scapula. Journal of Pediatric Orthopaedics B. 2002;11(1):85–8.
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10. Wu SJ, Chin LS, Kuo JR. Clinical experience of the Woodward procedure in Sprengel’s deformity. Formos J Surg. 2010;43:81–6.
11. Cho TJ, Choi IH, Chung CY, Hwang JK. The Sprengel deformity: morphometric analysis using 3D-CT and its clinical relevance. The Journal of bone and joint surgery British volume. 2000;82(5):711–8.
12. Jindal N, Gupta P. Sprengel’s shoulder treated by the Woodward procedure: analysis of factors affecting functional and cosmetic outcome. Journal of children’s orthopaedics. 2012;6(4):291–6.
13. Ross DM, Cruess RL. The surgical correction of congenital elevation of the scapula. A review of seventy-seven cases. Clinical orthopaedics and related research. 1977;(125):17–23.
14. Majid OB, Alzaid SZ, Al-Zayed Z, Almonaie S, Albekairi AA, Ahmed M. Outcomes of Woodward’s Procedure for Sprengel’s Shoulder Using Neurophysiological Monitoring of the Brachial Plexus Without Clavicular Osteotomy: A Retrospective Study. Cureus [Internet]. 2021 Nov 21 [cited 2022 Jul 13];13(11). Available from: https://www.cureus.com/articles/75601-outcomes-of-woodwards-procedure-for-sprengels-shoulder-using-neurophysiological-monitoring-of-the-brachial-plexus-without-clavicular-osteotomy-a-retrospective-study
15. Jeannopoulos CL. Congenital elevation of the scapula. J Bone Joint Surg Am. 1952 Oct;34 A(4):883–92.
16. Robinson RA. The surgical importance of the clevicular component of Sprengel’s deformity. J Bone Joint Surg, A. 1967;49:1481.

How to Cite this Article:  Nayak T, Raje A, Ragase A, Kapoor L, Kumar VS, Khan SA | Modified  Woodward’s Procedure in the Management of Neglected Sprengel’s Shoulder | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 02-05.  https://doi.org/10.13107/ijpo.2022.v08i02.136

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Percutaneous Retrograde Extraphyseal screw fixation for Type II and III Anterior Tibial Spine Avulsion Fractures: A Technical Note

Volume 8 | Issue 2 | May-August 2022 | Page: 16-19 | R M Chandak, Mohit Sharma, Amit Nemade

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.140

Authors: R M Chandak [1], Mohit Sharma [1], Amit Nemade [2]

[1] Department of Orthopedics & Trauma, Chandak Nursing Home, Nagpur, Maharashtra, India.
[2] Department of Orthopedics, Kids Orth Clinic, Nagpur, Maharashtra, India.

Address of Correspondence
Dr. Amit Nemade,
Consultant Pediatric Orthopedic Surgeon, Kids Orth Clinic, Nagpur, Maharashtra, India.
E-mail: kidsorth@gmail.com

Abstract

Introduction: Anterior tibial spine avulsion (ATSA) fractures are uncommon intra-articular knee injuries in children. They are common in adolescents. Treatment for displaced ATSA fracture is fixation. Various methods of fixation are documented, most common being arthroscopic assisted fixation using various sutures or anchors. Antegrade screw fixation is also an accepted method of treatment but is associated with implant back out and impingement. We describe our technique of retrograde extraphyseal percutaneous fixation for type II and III ATSA fractures.
Method: Under image intensifier (IITV) guidance, fracture reduction was achieved and fixed with a specially designed, short-threaded, 4mm cannulated screw. The screw was inserted in retrograde fashion proximal to the proximal tibial physis. The patient was immobilized in a cylinder cast and was allowed weight bearing as tolerated. Cast was removed at 6 weeks and range of movement exercises started.
Result: Our technique of percutaneous retrograde extraphyseal screw fixation for ATSA fracture is simple. The learning curve is less and can be used in selected case. In resource-limited situations where facilities for arthroscopy are not readily available, our technique can provide good results
Keywords: Anterior tibial spine avulsion, Percutaneous fixation, Retrograde, extraphyseal.

References

[1] Adams AJ, Talathi NS, Gandhi JS, Patel NM, Ganley TJ. Tibial Spine Fractures in Children: Evaluation, Management, and Future Directions. J Knee Surg. 2018;31(5):374–81.
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[3] Hallam PJB, Fazal MA, Ashwood N, Ware HE, Glasgow MMS, Powell JM. An alternative to fixation of displaced fractures of the anterior intercondylar eminence in children. J Bone Jt Surg – Ser B. 2002;84(4):579–82.
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[7] Louis M-L, Guillaume J-M, Toth C, Launay F, Jouve J-L, Bollini G. Fracture de l’éminence intercondylienne du tibia de type II chez l’enfant. Rev Chir Orthop Reparatrice Appar Mot. 2007;93(1):56–62.
[8] Mann MA, Desy NM, Martineau PA. A new procedure for tibial spine avulsion fracture fixation. 2012;2395–8.
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[10] Herman MJ, Martinek MA, Abzug JM. Complications of tibial eminence and diaphyseal fractures in children: prevention and treatment. Instr Course Lect. 2015;64:471–82.
[11] Ando T, Nishihara K. Arthroscopic internal fixation of fractures of the intercondylar eminence of the tibia. Arthroscopy. 1996;12(5):616–22.
[12] Xu X, Liu Z, Wen H, Pan X. Arthroscopic fixation of pediatric tibial eminence fractures using suture anchors: a mid-term follow-up. Arch Orthop Trauma Surg. 2017;137(10):1409–16.
[13] Xu P, Liu LC, Chen QJ, Yang P, Chen X Bin, Xie XP. The clinical effect and safety of the treatment of tibia intercondylar eminence fracture with cannulated screw and suture fixation under arthroscope: Protocol for a systematic review and meta-analysis of randomized controlled trials. Med (United States). 2020;99(23).
[14] Watts CD, Larson AN, Milbrandt TA. Open versus arthroscopic reduction for Tibial eminence fracture fixation in children. J Pediatr Orthop. 2016;36(5):437–9.
[15] Shin CH, Lee DJ, Choi IH, Cho TJ, Yoo WJ. Clinical and radiological outcomes of arthroscopically assisted cannulated screw fixation for tibial eminence fracture in children and adolescents. BMC Musculoskelet Disord. 2018;19(1):1–9.

How to Cite this Article:  Chandak RM, Sharma M, Nemade A |  Percutaneous Retrograde Extraphyseal screw fixation for Type II and III Anterior Tibial Spine Avulsion Fractures: A Technical Note | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 16-19. https://doi.org/10.13107/ijpo.2022.v08i02.140

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