Cai Wenquan,Su Yuxi,Qin Jiaqiang,et al.Clinical efficacy of distal tibial fractures in children with external fixation with joint[J].Journal of Clinical Pediatric Surgery,,20():677-680.[doi:10.12260/lcxewkzz.2021.07.016]
Clinical efficacy of distal tibial fractures in children with external fixation with joint
- Keywords:
- Tibial Fractures; Fracture Fixation; Treatment Outcome; Child
- CLC:
- R726.834.23;R726.8
- Abstract:
- Objective To explore the clinical efficacy of external fixation with joint for distal tibia fractures in children.Methods A total of 49 children with closed distal tibia fractures undergoing manual reduction from January 2010 to December 2016 were enrolled.There were 34 boys and 15 girls with an average age of 12.3 (8.5-16.2) Years.The involved side was right (n=39) and left (n=10).The operation was performed under the surveillance of X-ray machine.Ankle joint was axially pulled.According to the type of fracture,internal or external rotation of foot was achieved.After anatomical reduction,external fixation with joint was fixed.The distal screw of stent was fixed on talus neck and calcaneus and proximal end fixed on proximal tibia.If fracture ends were embedded with soft tissue obstruction,open reduction was required.X-ray examination was performed during operation to determine the anatomical reduction of fracture and fracture gap was <2 mm.There was no need for plaster fixation post-operation.Ambulation occurred at Week 1 and moving ankle joints within 3 weeks.Results Thirty cases were closed and reset and 19 cases were fixed by limited open reduction.The average follow-up period was 38(12-90) months.Final X-ray examination showed that bone healed without unevenness of joint surface.There was no varus or shortening deformity of ankle joint.And external fixator was removed at Weeks 5-8.The outcomes of AOFAS scoring system were excellent (n=39),decent (n=9) and fair (n=1).All children resumed normal physical activities.Conclusion External joint fixation is satisfactory for distal radius fractures in children.It can better restore the surface level of ankle joint,early weight bearing and avoid ankle joint stiffness.It is an excellent option for treating humeral fractures in children.
References:
1 Babis GC,Vayanos ED,Papaioannou N,et al.Results of surgical treatment of tibial plafond fractures[J].Clin Orthop Relat Res,1997,341:99-105.
2 Salter RB.Injuries involving the epiphyseal plate[J].Journal of Bone & Joint Surgery American Volume,1963,45(10):1414-1420.
3 Tarkin IS,Clare MP,Marcantonio A,et al.An update on the management of high-energy pilon fractures[J].Injury,2008,39(2):142-154.DOI:10.1016/j.injury.2007.07.024.
4 Korkmaz A,Ciftdemir M,Ozcan M,et al.The analysis of the variables,affecting outcome in surgically treated tibia pilon fractured patients[J].Injury,2013,44(10):1270-1274.DOI:10.1016/j.injury.2013.06.016.
5 Gustilo RB,Anderson JT.Prevention of infection in the treatment of one thousand and twenty five open fracture of long bones:Retrospective and prospective analysis[J].J Bone Joint Surg Am,1976,58(4):453-458.
6 Oh JK,Hwang JH,Sahu D,et al.Complication rate and pitfalls of temporary bridging external fixator in periarticular communited fractures[J].Clin Orthop Surg,2011,3(1):62-68.DOI:10.4055/cios.2011.3.1.62.
7 Olgun ZD,Maestre S.Management of pediatric ankle fractures[J].Curr Rev Musculoskelet Med,2018,11(3):475-484.DOI:10.1007/s12178-018-9510-3.
8 Seel EH,Noble S,Clarke NM,et al.Outcome of distal tibial physeal injuries[J].J Pediatr Orthop B,2011,20(4):242-248.DOI:10.1097/BPB.0b013e3283467202.
9 Spiegel PG,Cooperman DR,Laros GS.Epiphyseal fractures of the distal ends of the tibia and fibula.A retrospective study of two hundred and thirty-seven cases in children[J].J Bone Joint Surg Am,1978,60(8):1046-1050.
10 Kling TF Jr,Bright RW,Hensinger RN.Distal tibial physeal fractures in children that may require open reduction[J].J Bone Joint Surg Am,1984,66(5):647-657.
11 Cass JR,Peterson HA.Salter-Harris type-Ⅳ injuries of the distal tibial epiphyseal growth plate,with emphasis on those involving the medial malleolus[J].J Bone Joint Surg Am,1983,65(8):1059-1070.
12 Parikh SN,Mehlman CT.The community orthopaedic surgeon taking trauma call:pediatric ankle fracture pearls and pitfalls[J].J Orthop Trauma,2017,6:S27-S31.DOI:10.1097/BOT.0000000000001014.
13 焦勤,董良超,王林,等.空心螺钉内固定治疗青少年胫骨远端骨骺骨折的疗效观察[J].中华实用儿科临床杂志,2016,31(23):1809-1812.DOI:10.3760/cma.j.issn.2095-428X.2016.23.013. Jiao Q,Dong LC,Wang L,et al.Clinical observation of cannulated screw fixation for distal tibial epiphysis fracture in adolescents[J].Chin J Appl Clin Pdeiatr,2016,31(23):1809-1812.DOI:10.3760/cma.j.issn.2095-428X.2016.23.013.
14 石青,杨建平,龚仁钰,等.手法复位空心螺钉固定治疗儿童胫骨远端三平面骨折[J].中华骨科杂志,2010,30(9):876-881.DOI:10.3760/cma.j.issn.0253-2352.2010.09.010. Shi Q,Yan JP,Gong RY,et al.Clinical observation of cannulated screw fixation for distal tibial epiphysis fracture in adolescents[J].Chin J Orthop,2010,30(9):876-881.DOI:10.3760/cma.j.issn.0253-2352.2010.09.010.
15 刘伟军,王俊文,焦竞,等.两种不同外固定支架治疗胫骨远端骨折的疗效比较[J].中华创伤骨科杂志,2011,13(6):503-507.DOI:10.3760/cma.j.issn.1671-7600.2011.06.002. Wang WJ,Wang JW,Jiao J,et al.Unilateral versus bilateral external fixator in surgical treatment of distal tibial fracture[J].Chin J orthop Trauma,2011,13(6):503-507.DOI:10.3760/cma.j.issn.1671-7600.2011.06.002.
Memo
收稿日期:2018-09-25。
通讯作者:宿玉玺,Email:yuxisu@vip.qq.com