Pediatric Type II Tibial Spine Fractures

Addressing the Treatment Controversy With a Mixed-Effects Model

Tibial Spine Research Group

Research output: Contribution to journalArticle

Abstract

Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P <.001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P =.01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.

Original languageEnglish (US)
JournalOrthopaedic Journal of Sports Medicine
Volume7
Issue number8
DOIs
StatePublished - Aug 1 2019

Fingerprint

Tibial Fractures
Spine
Pediatrics
Therapeutics
Risk-Taking
Knee Injuries
Athletic Injuries
Surgeons
Decision Making
Cross-Sectional Studies
Wounds and Injuries

Keywords

  • pediatric
  • tibial spine fracture
  • treatment decision making
  • type II Meyers McKeever

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Pediatric Type II Tibial Spine Fractures : Addressing the Treatment Controversy With a Mixed-Effects Model. / Tibial Spine Research Group.

In: Orthopaedic Journal of Sports Medicine, Vol. 7, No. 8, 01.08.2019.

Research output: Contribution to journalArticle

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title = "Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model",
abstract = "Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85{\%} of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P <.001). Surgeons were 28{\%} more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64{\%} of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P =.01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.",
keywords = "pediatric, tibial spine fracture, treatment decision making, type II Meyers McKeever",
author = "{Tibial Spine Research Group} and Adams, {Alexander J.} and O’Hara, {Nathan N.} and Abzug, {Joshua M.} and Aoyama, {Julien T.} and Ganley, {Theodore J.} and Carey, {James L.} and Cruz, {Aristides I.} and Ellis, {Henry B.} and Fabricant, {Peter D.} and Green, {Daniel W.} and Heyworth, {Benton E.} and Janicki, {Joseph A.} and Kocher, {Mininder S.} and Lawrence, {John T.R.} and Rushyuan Lee and McKay, {Scott D.} and Mistovich, {R. Justin} and Patel, {Neeraj M.} and Polousky, {John D.} and Rhodes, {Jason T.} and Sachleben, {Brant C.} and Sargent, {M. Catherine} and Schmale, {Gregory A.} and Shea, {Kevin G.} and Yen, {Yi Meng}",
year = "2019",
month = "8",
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TY - JOUR

T1 - Pediatric Type II Tibial Spine Fractures

T2 - Addressing the Treatment Controversy With a Mixed-Effects Model

AU - Tibial Spine Research Group

AU - Adams, Alexander J.

AU - O’Hara, Nathan N.

AU - Abzug, Joshua M.

AU - Aoyama, Julien T.

AU - Ganley, Theodore J.

AU - Carey, James L.

AU - Cruz, Aristides I.

AU - Ellis, Henry B.

AU - Fabricant, Peter D.

AU - Green, Daniel W.

AU - Heyworth, Benton E.

AU - Janicki, Joseph A.

AU - Kocher, Mininder S.

AU - Lawrence, John T.R.

AU - Lee, Rushyuan

AU - McKay, Scott D.

AU - Mistovich, R. Justin

AU - Patel, Neeraj M.

AU - Polousky, John D.

AU - Rhodes, Jason T.

AU - Sachleben, Brant C.

AU - Sargent, M. Catherine

AU - Schmale, Gregory A.

AU - Shea, Kevin G.

AU - Yen, Yi Meng

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P <.001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P =.01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.

AB - Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P <.001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P =.01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.

KW - pediatric

KW - tibial spine fracture

KW - treatment decision making

KW - type II Meyers McKeever

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DO - 10.1177/2325967119866162

M3 - Article

VL - 7

JO - Orthopaedic Journal of Sports Medicine

JF - Orthopaedic Journal of Sports Medicine

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