Proximal tibia Extraarticular fracture, avulsion of tibial spine

1 Principles top

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Choice of fixation technique

Suturing is the best alternative to screw fixation if the avulsion fragment is small or comminuted.

Avulsion of anterior cruciate ligament is most often seen in the younger patient.

2 Patient preparation top

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This procedure is normally performed with the patient in a supine position.

3 Approach top

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For this procedure an anterolateral approach is used.

4 Reduction top

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Ball-spiked pusher

The fracture is visualized with the arthroscope and reduction is attempted with a hook or another instrument inserted through another portal.

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Clamps

In open procedures, the avulsed bony fragment of the intercondylar eminence is addressed directly and may be reduced with the help of clamps or wires.

5 Fixation top

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Drill holes

Drill two holes from the ACL base, one medial and one lateral.

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Apply suture

Place the sutures around the base of the anterior cruciate ligament (ACL), pass them through the holes, make a knot and tighten it.