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Background: Tibial spine fractures (TSFs) are uncommon injuries that may result in substantial morbidity in children. A variety of open and arthroscopic techniques are used to treat these fractures, but no single standardized operative method has been identified. Purpose: To systematically review the literature on pediatric TSFs to determine the current treatment approaches, outcomes, and complications. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review of the literature was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines using PubMed, Embase, and Cochrane databases. Studies evaluating treatment and outcomes of patients <18 years old were included. Patient demographic characteristics, fracture characteristics, treatments, and outcomes were abstracted. Descriptive statistics were used to summarize categorical and quantitative variables, and a meta-analytic technique was used to compare observational studies with sufficient data. Results: A total of 47 studies were included, totaling 1922 TSFs in patients (66.4% male) with a mean age of 12 years (range, 3-18 years). The operative approach was open reduction and internal fixation in 291 cases and arthroscopic reduction and internal fixation in 1236 cases; screw fixation was used in 411 cases and suture fixation, in 586 cases. A total of 13 nonunions were reported, occurring most frequently in Meyers and McKeever type III fractures (n = 6) and in fractures that were treated nonoperatively (n = 10). Arthrofibrosis rates were reported in 33 studies (n = 1700), and arthrofibrosis was present in 190 patients (11.2%). Range of motion loss occurred significantly more frequently in patients with type III and IV fractures (P <.001), and secondary anterior cruciate ligament (ACL) injury occurred most frequently in patients with type I and II fractures (P =.008). No statistically significant differences were found with regard to rates of nonunion, arthrofibrosis, range of motion loss, laxity, or secondary ACL injury between fixation methods (screw vs suture). Conclusion: Despite variation in TSF treatment, good overall outcomes have been reported with low complication rates in both open and arthroscopic treatment and with both screw and suture fixation. Arthrofibrosis remains a concern after surgical treatment for TSF, but no significant difference in incidence was found between the analysis groups. Larger studies are necessary to compare outcomes and form a consensus on how to treat and manage patients with TSFs. [ABSTRACT FROM AUTHOR]

Objectives: Tibial spine fractures (TSFs) are avulsion fractures at the insertion of the anterior cruciate ligament at the tibial intercondylar eminence. TSFs are rare injuries thought to occur most frequently in skeletally immature children aged 8 to 14 years. Historically, it was thought that the most common mechanism was falling off of bicycles, but recent research suggests a variety of additional mechanisms. Treatment for TSFs can be operative or nonoperative depending on fracture type/severity, concomitant injuries, and surgeon and patient/family preference. Estimates of the epidemiology of this patient population are limited to primarily single-center reports. The objective of this investigation was to characterize epidemiology, including demographic information, injury mechanism, fracture type, and selection of surgical or nonsurgical treatment, in this injury population across eight geographically distinct institutions using retrospective data. Methods: IRB and reliance approval was obtained for each participating hospital. Patients younger than 25 years treated for TSFs between January 1, 2000 and January 31, 2019 were included. Patients with multiple lower extremity fractures or other traumatic injuries were excluded. Data was collected regarding demographics, mechanisms of injury, imaging reports, treatment, and concomitant injuries. Data were presented as medians and interquartile ranges. Categorical data was presented as counts and percentages and was stratified by sex and/or Meyers and McKeever fracture type. Results: 661 patients met inclusion criteria. Median age at presentation was 12.2 years (IQR 9.714.1), with a higher prevalence in boys than girls (66.1%, 437/661). Diagnosis at a study center occurred at a median of 4.0 days (IQR 1.0-9.0 days) after injury. Of these patients, 71.6% (432/603) had first been seen elsewhere, most commonly by emergency department physicians (40.7%, 176/432). The most commonly reported injury mechanisms were contact (44.4%, 244/549) and twisting, non-contact (42.8%, 235/549), with hyperextension injuries representing a much smaller proportion at 3.6%. Injuries occurred most frequently during sports at 56.8% (355/625), which were primarily skiing (127/352, 36.1%) and football (97/352, 27.6%). Distal femur and proximal tibia growth plate status were classified as open in 67.1% and 72.6% of cases, respectively. Both growth plates were classified as closed in only 5.8% of cases. Meyers and McKeever fracture type was most commonly Type II (40.4%) or Type III (44.4%). Treatment was surgical in 83.3% (549/659) of cases, and of these, most were treated arthroscopically (ARIF) (470/549, 86.1%). Conclusions: This study represents, to our knowledge, the largest epidemiological report to date of pediatric patients with tibial spine fractures. TSFs were more common in males than females (66.1% male), and the median age at injury was 12.2 years, which falls within the commonly reported range of 8-14 years. Furthermore, only 5.8% of patients had closed regional physes, corroborating the theory that TSFs are more likely to occur in skeletally immature individuals. We believe the data presented in this study can be useful towards patient counselling by providing a comprehensive view of the common presentations of and treatment pathways for tibial spine fractures in the pediatric population. [ABSTRACT FROM AUTHOR]

PURPOSE Pediatric oncology and bone marrow transplant patients are at high risk of infection, and limitations to dental expertise among medical providers render patients vulnerable to central line–associated bloodstream infections from oral pathogens. Traditionally, oral health maintenance relied on patients and bedside nurses; however, routine methods are often suboptimal to prevent central line–associated bloodstream infection in high-risk patients. Limited overlap of medical and dental expertise, and limited dental resources in typical oncology units, prevent optimal oral care for children with cancer, requiring novel solutions to better integrate specialties. METHODS Here, we outline the creation of a novel Pediatric oncodental team to address oral-systemic infection prevention strategies for high-risk patients. RESULTS Our oncology and dental teams created a systematic approach for increasing oral surveillance and treatment in select high-risk patients. Supervised pediatric dental residents participated in scheduled oncology rounds, and a permanent oral health educator with a background in dental hygiene was also hired as a dedicated dental professional within our oncology department. CONCLUSION Our pediatric oncodental team aims to sustain optimal oral complication prevention strategies to reduce the risk of infection, provide education on the significance of the oral-systemic link in cancer care, and improve access and continuity of care. [ABSTRACT FROM AUTHOR]