What Are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures? A Multicenter Study

Haley E. Smith, Aristides I. Cruz, R. Justin Mistovich, Tomasina M. Leska, Theodore J. Ganley, Julien T. Aoyama, Henry B. Ellis, Indranil Kushare, Rushyuan J. Lee, Scott D. McKay, Todd A. Milbrandt, Jason T. Rhodes, Brant C. Sachleben, Neeraj M. Patel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The uncommon nature of tibial spine fractures (TSFs) may result in delayed diagnosis and treatment. The outcomes of delayed surgery are unknown. Purpose: To evaluate risk factors for, and outcomes of, delayed surgical treatment of pediatric TSFs. Study Design: Cohort study; Level of evidence, 3. Methods: The authors performed a retrospective cohort study of TSFs treated surgically at 10 institutions between 2000 and 2019. Patient characteristics and preoperative data were collected, as were intraoperative information and postoperative complications. Surgery ≥21 days after injury was considered delayed based on visualized trends in the data. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounders. Results: A total of 368 patients (mean age, 11.7 ± 2.9 years) were included, 21.2% of whom underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF at ≥1 weeks after injury (95% CI, 1.1-14.3; P =.04), 2.1 times higher odds of having seen multiple clinicians before the treating surgeon (95% CI, 1.1-4.1; P =.03), 5.8 times higher odds of having magnetic resonance imaging (MRI) ≥1 weeks after injury (95% CI, 1.6-20.8; P <.007), and were 2.2 times more likely to have public insurance (95% CI, 1.3-3.9; P =.005). Meniscal injuries were encountered intraoperatively in 42.3% of patients with delayed surgery versus 21.0% of patients treated without delay (P <.001), resulting in 2.8 times higher odds in multivariate analysis (95% CI, 1.6-5.0; P <.001). Delayed surgery was also a risk factor for procedure duration >2.5 hours (odds ratio, 3.3; 95% CI, 1.4-7.9; P =.006). Patients who experienced delayed surgery and also had an operation >2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI, 1.1-12.5; P =.03). Conclusion: Patients who underwent delayed surgery for TSFs were found to have a higher rate of concomitant meniscal injury, longer procedure duration, and more postoperative arthrofibrosis when the surgery length was >2.5 hours. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery.

Original languageEnglish (US)
JournalOrthopaedic Journal of Sports Medicine
Issue number3
StatePublished - Mar 2 2022
Externally publishedYes


  • pediatric knee
  • pediatric sports medicine
  • tibial eminence
  • tibial spine

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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