Domzalski Marcin E, Lipton Glenn E, Lee Daniel, Guille James T
Department of Orthopaedics, Medical University of Lodz, Poland.
J Pediatr Orthop. 2006 Mar-Apr;26(2):171-6. doi: 10.1097/01.bpo.0000218523.82996.76.
Fractures of the tibia are common in children. Fractures of the distal tibial metaphysis have been only described in fracture texts without reference to a peer-reviewed study. The purpose of the present study was to review this fracture pattern and report the results of treatment.
The medical records and radiographs of children seen at our institution with a fracture of the tibia were reviewed. The patients with fractures of the distal tibial metaphysis who had been followed until healing were included. Fractures of the distal tibial diaphysis, toddler's fractures, and pathologic fractures were excluded.
Twenty-six children met these criteria and were included in the study. The mechanism of injury was indirect in 13 fractures and direct in 12 fractures. In 1 patient, the mechanism of injury was unknown. The main cause of indirect injury was fall (11 cases). The most common was the transverse type of fracture (14 patients) followed by the oblique type (11 patients). Only 8 cases were nondisplaced. Valgus angulation was usually associated with a recurvatum deformation, whereas varus angulation was associated with procurvatum angulation. These patterns were present in 14 patients. We observed shorter healing time when the fracture was oblique than transverse. Children with the oblique pattern of injury were younger than children with a transverse fracture.
The patterns of displacement of the distal tibial metaphyseal fractures reported in our study vary from those presented in textbooks. Distal tibial metaphyseal fractures can present with 2 types of displacement: valgus recurvatum and varus procurvatum. Fractures of the fibula always present with the same pattern as the tibia. Primary union of the distal tibial metaphyseal fracture may be expected in all cases regardless of the type of fracture, age, and gender.
胫骨骨折在儿童中很常见。胫骨远端干骺端骨折仅在骨折相关文献中有所描述，并无同行评议研究的参考文献。本研究的目的是回顾这种骨折类型并报告治疗结果。
回顾了在我们机构就诊的胫骨骨折儿童的病历和X线片。纳入随访至骨折愈合的胫骨远端干骺端骨折患者。排除胫骨远端骨干骨折、幼儿骨折和病理性骨折。
26名儿童符合这些标准并纳入研究。13例骨折的损伤机制为间接损伤，12例为直接损伤。1例患者的损伤机制不明。间接损伤的主要原因是跌倒（11例）。最常见的骨折类型是横行骨折（14例患者），其次是斜行骨折（11例患者）。仅8例无移位。外翻成角通常伴有膝反张畸形，而内翻成角则伴有前凸成角。14例患者出现这些模式。我们观察到斜行骨折的愈合时间比横行骨折短。斜行损伤模式的儿童比横行骨折的儿童年龄小。
我们研究中报告的胫骨远端干骺端骨折的移位模式与教科书中描述的不同。胫骨远端干骺端骨折可出现两种移位类型：外翻膝反张和内翻前凸。腓骨骨折的移位模式总是与胫骨相同。无论骨折类型、年龄和性别如何，所有病例的胫骨远端干骺端骨折均可实现一期愈合。
