Abstract
The purpose of this study was to determine the variability in clinical management of tibial tubercle fractures among a group of pediatric orthopedic surgeons. Nine fellowship-trained academic pediatric orthopedic surgeons reviewed 51 anteroposterior and lateral knee radiographs with associated case age. Respondents were asked to describe each fracture using the Ogden classification (type 1-5 with A/B modifiers), desired radiographic workup, operative vs. nonoperative treatment strategy and plans for post-treatment follow-up. Fair agreement was reached when classifying the fracture type using the Ogden classification (k = 0.39; P < 0.001). overall, surgeons had a moderate agreement on whether to treat the fractures operatively vs. nonoperatively (k =" 0.51;" p >< 0.001). nonoperative management was selected for 80.4% (45 56) of type 1a fractures. respondents selected operative treatment for 75% (30 40) of type 1b, 58.3% (14 24) of type 2a, 97.4% (74 76) of type 2b, 90.7% (39 43) of type 3a, 96.3% (79 82) of type 3b, 71.9% (87 121) of type 4 and 94.1% (16 17) of type 5 fractures. regarding operative treatment, fair slight agreement was reached when selecting the specifics of operative treatment including surgical fixation technique (k =" 0.25;" p >< 0.001), screw type (k =" 0.26;" p >< 0.001), screw size (k =" 0.08;" p >< 0.001), use of washers (k =" 0.21;" p >< 0.001) and performing a prophylactic anterior compartment fasciotomy (k =" 0.20;" p >< 0.001). furthermore, surgeons had fair moderate agreement regarding the specifics of nonoperative treatment including degree of knee extension during immobilization (k =" 0.46;" p >< 0.001), length of immobilization (k =" 0.34;" p >< 0.001), post-treatment weight bearing status (k =" 0.30;" p >< 0.001) and post-treatment rehabilitation (k =" 0.34;" p >< 0.001). significant variability exists between surgeons when evaluating and treating pediatric tibial tubercle fractures.>
