Caillon F, Rigault P, Padovani J P, Janklevicz P, Langlais J, Touzet P
Service d'Orthopédie Traumatologie Infantile, Hôpital des Enfants, Malades, Paris.
Chir Pediatr. 1990;31(6):322-32.
We review 58 cases of proximal tibial fractures in children. Their evolution and prognostic depend on the localisation. The intra epiphyseal fractures have a good prognostic if care is taken in reduction of the great deplacement fractures: as well as the epiphyseal plate fractures. The upper anterior tibial apophysis fractures have been reduced and screwed without any genu recurvatum sequellae. Severe growth disorder may follow proximal tibial contusions without parallelism regarding to them. Among the iatrogenic causes of these contusions, the trans-tibial pine traction may induce a genu recurvatum even far from the tibial tubercle: so we must avoid this method. The proximal metaphyseal tibial fractures and the valgus deformity following them represents a high difficult treatment. This deformity often recurs after osteotomy (with the risks of the operation). Anyway the tibia valga disappears spontaneously. Its evolution shows that it has a double origin: the fracture displacement then the medial overgrowth epiphyseal plate. The first cause can be treatment actually in order to limit the final valgus by closed reduction with anesthesia.
我们回顾了58例儿童胫骨近端骨折病例。其病情发展及预后取决于骨折部位。骨骺内骨折若能小心处理严重移位骨折，预后良好，骨骺板骨折亦是如此。胫骨前上髁骨折经复位及螺钉固定后未出现膝反屈后遗症。胫骨近端挫伤后可能会出现严重的生长紊乱，但二者之间并无平行关系。在这些挫伤的医源性原因中，经胫骨髁上牵引即使远离胫骨结节也可能导致膝反屈，因此我们必须避免这种方法。胫骨近端干骺端骨折及其后的外翻畸形治疗难度很大。这种畸形在截骨术后常复发（存在手术风险）。无论如何，胫骨外翻会自然消失。其病情发展表明其有双重成因：骨折移位以及骨骺板内侧过度生长。第一个原因目前可通过麻醉下闭合复位治疗，以限制最终的外翻程度。
