Pediatric tibial eminence fractures are increasingly managed operatively, yet the optimal fixation technique remains debated. Suture fixation has gained popularity as a physeal-sparing alternative to screw fixation, aiming to reduce hardware-related complications while maintaining joint stability. This systematic review and meta-analysis compared clinical and functional outcomes between suture fixation and screw fixation in skeletally immature patients. Four comparative studies involving 224 pediatric patients were included. Suture fixation demonstrated a significantly lower reoperation rate (OR 0.22, 95% CI 0.12–0.42) and markedly reduced hardware removal rates (OR 0.08, 95% CI 0.03–0.19). Return-to-sport outcomes favored suture fixation (OR 2.71, 95% CI 1.15–6.39). No significant differences were observed between techniques in postoperative instability, arthrofibrosis requiring surgical intervention, or full range-of-motion recovery. These findings suggest that suture fixation provides meaningful clinical advantages by reducing implant-related morbidity while preserving comparable functional outcomes. Based on current evidence, suture fixation should be considered a preferred option in appropriately selected pediatric patients with displaced tibial eminence fractures.

Ahmed Elnewishy (MBChB, MSc, MRCS) is a Trauma and Orthopaedics Specialty Registrar at Maidstone and Tunbridge Wells NHS Trust, United Kingdom. He graduated from Cairo University in 2017 and has since developed a strong academic and clinical interest in pediatric orthopaedics, trauma surgery, and evidence-based surgical decision-making. He has authored multiple systematic reviews and meta-analyses published in peer-reviewed journals and is actively involved in surgical training, research, and quality improvement initiatives within the NHS. His work focuses on optimizing operative techniques and improving functional outcomes in musculoskeletal trauma.