Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients  Itai Gans, B.S., Oladapo M. Babatunde, M.D., Theodore J. Ganley, M.D.  Arthroscopy Techniques  Volume 2, Issue 3, Pages e237-e242 (August 2013) DOI: 10.1016/j.eats.2013.02.013 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig 1 Type III and type IV tibial eminence fractures can be fixed by arthroscopic reduction and internal fixation in a 2-step process (initial and secondary fixation). Initial fixation of the tibial eminence fracture is achieved through a midpatellar portal with a bioabsorbable compression screw. (A) After provisional fixation with 2 K-wires, a transparent cannula is threaded over 1 of the K-wires; the corresponding drill and then the corresponding bone tap are used to prepare the bone for screw placement. (B) The K-wire within the cannula is removed; the compression screw can then be implanted and the second K-wire removed. (C) Final location and placement of compression screw in tibial eminence fracture is shown. © Theodore J. Ganley. Arthroscopy Techniques 2013 2, e237-e242DOI: (10.1016/j.eats.2013.02.013) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig 2 After provisional fixation, secondary fixation (variation A) for type III tibial eminence fractures with a bioabsorbable compression screw and suture can be performed. The arrows in A and C indicate the location of the previously placed bioabsorbable compression screw. (A) A tibial tunnel drill guide is used to drill 2 channels from the anterior aspect of the tibia into the joint space. High-strength suture is then passed into the joint space through the drill guide. (B) This process is repeated for the second bone channel. The bone channels (and suture) should be placed such that 1 passes medially and 1 passes on the lateral aspect of the fracture fragment. After creating a loop with 1 of the suture limbs by using the second to guide it down through the second tibial bone tunnel, the surgeon ties the suture over the anterior tibia. (C, D) Two views of the final fixation achieved with a screw and suture fixation. The arrowheads in D mark the positions of the tibial bone tunnels drilled with the ACL guide. © Theodore J. Ganley. Arthroscopy Techniques 2013 2, e237-e242DOI: (10.1016/j.eats.2013.02.013) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig 3 After provisional fixation, secondary fixation (variation B) for type IV comminuted tibial eminence fractures with a bioabsorbable compression screw and shoulder anchor fixation can be performed. A technique similar to basic shoulder labral repair is performed. (A) First, a curved suture passing device is placed through the base of the ACL. (B) This device is used to feed high-strength suture that will be anchored into the tibia. The suture that is passed through the ACL is luggage tagged and anchored to the anterior tibia, angled slightly anterior to posterior. (C) Final fixation achieved with screw and shoulder anchor fixation. © Theodore J. Ganley. Arthroscopy Techniques 2013 2, e237-e242DOI: (10.1016/j.eats.2013.02.013) Copyright © 2013 Elsevier Inc. Terms and Conditions