Roberts J M
Springfield Unit, Shriners Hospital for Crippled Children, Massachusetts.
Orthop Clin North Am. 1990 Apr;21(2):365-79.
It should be emphasized that most fractures about the knee in children and adolescents can be treated by closed methods. It follows that open reduction and fixation is employed when closed reduction fails. An interposed flap of torn periosteum may prevent closed reduction. Internal fixation is often required in avulsion fractures of the tibial tubercle, reduced displaced fracture-separations of the proximal tibial epiphysis, fracture-separations of the distal femoral epiphysis displaced in the sagittal plane, and displaced Salter-Harris type III and IV fracture-separations. A displaced avulsion of the anterior intercondylar eminence of the tibia can sometimes be reduced using closed means but more often requires reduction by arthrotomy or with arthroscopy. Late reconstruction for ensuing leg length discrepancy, angular deformity, or instability may be indicated.
需要强调的是，儿童和青少年的大多数膝关节周围骨折可以通过闭合方法治疗。因此，当闭合复位失败时采用切开复位内固定。撕裂的骨膜插入瓣可能会妨碍闭合复位。胫骨结节撕脱骨折、胫骨近端骨骺移位骨折分离、股骨远端骨骺矢状面移位骨折分离以及Salter-Harris III型和IV型移位骨折分离通常需要内固定。胫骨髁间前棘移位撕脱有时可用闭合方法复位，但更多时候需要通过关节切开术或关节镜进行复位。对于随后出现的腿长差异、角畸形或不稳定，可能需要进行后期重建。
