Trends in Magnetic Resonance Imaging Utilization and Treatment of Pediatric Tibial Spine Fractures: A National Database Study.

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, P ​< ​.0001), fracture displacement (OR ​= ​2.38, P ​< ​.0001), and geographic region (Midwest relative to West, OR ​= ​1.57, P ​= ​.0013). A total of 806 patients (22.7%) underwent surgical management, with fracture displacement (OR ​= ​14.13, P ​< ​.0001) ​and preoperative MRI (OR ​= ​7.44, P ​< ​.0001) identified as independent predictors of this treatment strategy. Of patients treated surgically, ARIF was performed for 522 patients (64.8%), with an independent predictor being preoperative MRI (OR ​= ​3.00, P ​< ​.0001). Notably, the rate of MRI utilization increased significantly through the study period (15.7% in 2016, 23.1% in 2022, R2 ​= ​0.795, P ​= ​.0170), while the rates of operative treatment and ARIF did not change significantly.

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.