ArticleJournal of the Pediatric Orthopaedic Society of North America2026
Trends in Magnetic Resonance Imaging Utilization and Treatment of Pediatric Tibial Spine Fractures: A National Database Study.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The management of pediatric tibial spine fractures is evolving as the evidence base has grown. Recent evidence suggests magnetic resonance imaging (MRI) evaluation may be warranted although optimal management is unknown. The present study sought to characterize national trends in surgical management and MRI utilization of pediatric tibial spine fractures. Methods: Patients aged 6-17 years presenting with a first diagnosis of closed tibial spine fracture were identified from the 2016-2022 PearlDiver M170 database. MRI utilization, treatment strategy, and surgical technique (arthroscopic reduction and internal fixation [ARIF], open reduction and internal fixation [ORIF], or anterior cruciate ligament reconstruction) were determined for each injury. Factors independently associated with these variables were assessed by a multivariable analysis. The year 2020 was excluded from analyses of trends due to changes to health care utilization during the COVID-19 pandemic. Results: Overall, 3,554 pediatric tibial spine fracture patients were identified. MRI was obtained for 681 patients (19.1%), with independent predictors of MRI use being increased age (odds ratio [OR] = 1.12 per year, Conclusions: In this large database study of pediatric tibial spine fractures featuring over 3,000 patients treated over nearly a decade, we identified that MRI was obtained for 19.1% of the study population. The rate of MRI utilization increased over the course of the study period. Moreover, surgery was performed on 22.7% of the population. There were geographic variations in MRI and ARIF utilization, suggesting nonclinical factors impacting management. Key Concepts: (1)Only a minority of tibial spine fracture patients received magnetic resonance imaging, despite recognition of the frequency of associated injury, though this percentage did increase over the study period.(2)Geographic variations in imaging and surgical treatment were identified, suggesting nonclinical factors impacting management.(3)Fracture displacement was the strongest predictor of surgical treatment, which was most commonly performed arthroscopically. Level of Evidence: III.
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