Brey Jennifer M, Conoley Jack, Canale S Terry, Beaty James H, Warner William C, Kelly Derek M, Sawyer Jeffrey R
Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Le Bonheur Children's Hospital, Memphis, TN, USA.
J Pediatr Orthop. 2012 Sep;32(6):561-6. doi: 10.1097/BPO.0b013e318263a370.
Tibial tuberosity fractures have been described as uncommon injuries, but their frequency appears to be increasing. Because of the relatively few cases reported in the literature, little is known regarding risk factors for complications. In a large group of adolescents with tibial tuberosity fractures, we noted more frequent complications in patients who had posterior metaphyseal fractures in addition to tibial tuberosity avulsion fractures. The purpose of this study was to examine the outcomes associated with this fracture pattern and compare them with tibial tuberosity fractures without the posterior component.
All patients who had closed or open reduction and internal fixation of a tibial tuberosity fracture between January 2003 and December 2010 were identified. All radiographs and medical records were reviewed.
Fifty-three tibial tuberosity fractures had radiographs available for review; 15 (28%) fractures had a posterior component identified by either radiograph or computed tomography scan. Four of these combined injuries had an adverse event: 1 patient had compartment syndrome affecting all 4 compartments and 3 patients had refractures after closed reduction and casting. None of the 38 tibial tuberosity fractures without a posterior metaphyseal component had these complications. All patients had complete fracture healing and had returned to full activity at last follow-up.
In this study, a posterior metaphyseal fracture associated with a tibial tuberosity fracture was a marker for potential complications. If radiographs suggest that a fracture line extends through the posterior metaphysis, computed tomography imaging is recommended to confirm the fracture pattern. Open reduction and internal fixation that includes both the anterior and posterior fragments is recommended for all fractures with these combined components, including nondisplaced fractures, because of an increased risk of refracture.
Level IV (case study).
胫骨结节骨折被描述为不常见的损伤，但它们的发生率似乎在上升。由于文献报道的病例相对较少，关于并发症的危险因素知之甚少。在一大群患有胫骨结节骨折的青少年中，我们注意到除胫骨结节撕脱骨折外还伴有后干骺端骨折的患者并发症更为常见。本研究的目的是检查与这种骨折类型相关的结果，并将其与不伴有后部骨折块的胫骨结节骨折进行比较。
确定2003年1月至2010年12月期间所有接受胫骨结节骨折闭合或切开复位内固定的患者。回顾所有的X线片和病历。
53例胫骨结节骨折有X线片可供复查；15例（28%）骨折通过X线片或计算机断层扫描发现有后部骨折块。这些合并损伤中有4例发生了不良事件：1例患者发生了累及所有4个骨筋膜室的骨筋膜室综合征，3例患者在闭合复位和石膏固定后发生了再骨折。38例无后干骺端骨折块的胫骨结节骨折均未发生这些并发症。所有患者骨折均完全愈合，在最后一次随访时已恢复全部活动。
在本研究中，与胫骨结节骨折相关的后干骺端骨折是潜在并发症的一个标志。如果X线片提示骨折线延伸至后干骺端，建议行计算机断层扫描成像以确认骨折类型。对于所有具有这些合并骨折块的骨折，包括无移位骨折，建议行切开复位内固定，固定前、后骨折块两者，因为再骨折风险增加。
IV级（病例研究）。
