An ultrasound-assisted technique to fix the avulsion fracture of the posterior tibial spine

Abstract

Background: The fixation of posterior tibial avulsion fractures has been predominantly open reduction and internal fixation that leads to longer incision, severe scarring and higher risk to neurovascular injury while using the posterior approach. The arthroscopic methods have a steep learning curve, and fracture fixation is usually with fibre wire. Aim: Ultrasound assisted fixation of PCL avulsion fracture. Material and Methods: The patient is placed prone; the limb is placed in 20-degree flexion and neutral rotation. The US is used to identify the popliteal artery and nerve. The blunt tip of a K wire is inserted under US guidance. After confirming the position with an image intensifier, a 3.5 mm cannulated screwdriver is passed over the K wire. The final reduction is confirmed with image intensifier in anteroposterior and lateral views. Results: We present 11 cases of the posterior tibial avulsion fracture, which have been fixed with percutaneous screw fixation. The procedure was done under image intensifier guidance and ultrasound assistance. We have a minimum 1 year and a maximum of 10 years of follow up, where most of the patients had an excellent outcome. Conclusion: The authors felt with the ultrasound-assisted fixation technique, there is minimal or no scarring with stronger fixation. The procedure is safe, devoid of morbidities associated with open reduction and can be easily replicated at most trauma centers.

Keywords

• minimally invasive technique
• posterior tibial avulsion fractures
• ultrasound-assisted fixation