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Background: There is a high rate of concomitant injuries reported in pediatric patients with tibial spine fractures, ranging from 40% to 68.8%. Many tibial spine fractures are treated without initial magnetic resonance imaging (MRI). Purpose: To understand rates of concomitant injury and if the reported rates of these injuries differed among patients with and without pretreatment MRI. Study Design: Cross-sectional study; level of evidence, 3. Methods: We performed an institutional review board–approved multicenter retrospective cohort study of patients treated for tibial spine fractures between January 1, 2000, and January 31, 2019, at 10 institutions. Patients younger than 25 years of age with tibial spine fractures were included. Data were collected on patient characteristics, injury, orthopaedic history, pretreatment physical examination and imaging, and operative findings. We excluded patients with multiple trauma and individuals with additional lower extremity fractures. Patients were categorized into 2 groups: those with and those without pretreatment MRI. The incidence of reported concomitant injuries was then compared between groups. Results: There were 395 patients with a tibial spine fracture who met inclusion criteria, 139 (35%) of whom were reported to have a clinically significant concomitant injury. Characteristics and fracture patterns were similar between groups. Of patients with pretreatment MRI, 79 of 176 (45%) had an identified concomitant injury, whereas only 60 of 219 patients (27%) without pretreatment MRI had a reported concomitant injury (P <.001). There was a higher rate of lateral meniscal tears (P <.001) in patients with pretreatment MRI than in those without. However, there was a higher rate of soft tissue entrapment at the fracture bed (P =.030) in patients without pretreatment MRI. Overall, 121 patients (87%) with a concomitant injury required at least 1 treatment. Conclusion: Patients with pretreatment MRI had a statistically significantly higher rate of concomitant injury identified. Pretreatment MRI should be considered in the evaluation of tibial spine fractures to improve the identification of concomitant injuries, especially in patients who may otherwise be treated nonoperatively or with closed reduction. Further studies are necessary to refine the indications for MRI in patients with tibial spine fractures, determine the characteristics of patients at highest risk of having a concomitant injury, define the sensitivity and specificity of MRI in tibial spine fractures, and investigate patient outcomes based on pretreatment MRI status. [ABSTRACT FROM AUTHOR]

Background: The uncommon nature of tibial spine fractures may result in delayed presentation, diagnosis, and treatment. Elucidation of the contributing factors to such delays may provide an opportunity to improve patient care. Additionally, the outcomes of delayed surgery are unknown. Hypothesis/Purpose: The purpose of this study is to evaluate risk factors for, and consequences of, delayed surgical treatment of pediatric tibial spine fractures. Methods: We performed a retrospective cohort study of tibial spine fractures treated surgically at 10 institutions between 2000 and 2019. Demographic and pre-operative data were collected, as was intra-operative information and post-operative complications. Attention was focused on delays in evaluation and treatment, which were treated as both continuous and categorical variables. Surgery ≥21 days after injury was considered "delayed". Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 368 subjects (mean age 11.7±2.9 years) were included, 21.2% of which underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF 1 or more weeks after injury [95% confidence interval (CI) 1.1-14.3, p=0.04], 2.3 times higher odds of having seen multiple clinicians prior to the treating surgeon (95% CI 1.1-4.8, p=0.02), 5.8 times higher odds of having magnetic resonance imaging 1 or more weeks after injury (MRI; 95% CI 1.6-20.8, p<0.007), and were 2.4 times more likely to have public insurance (95% CI 1.3-4.2, p=0.003). Meniscal injuries were encountered intra-operatively in 42.3% of those that had delayed surgery compared to 16.6% of patients that did not (p<0.001), resulting in 2.8 times higher odds in multivariate analysis (95% CI 1.6-5.0, p<0.001). Delayed surgery was also a risk factor for procedure duration longer than 2.5 hours (odds ratio 3.3, 95% CI 1.4-7.9; p=0.006). Patients who experienced delayed surgical management and an operation longer than 2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI 1.1-12.5, p=0.03). Conclusion: When surgery for a TSF was performed ≥21 days after injury, patients were at increased risk for concomitant meniscal pathology, longer case duration, and possibly post-operative arthrofibrosis. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery. These results provide an opportunity to optimize care for children that are at highest risk for delayed treatment. [ABSTRACT FROM AUTHOR]