Schneidmueller D, Sander A L, Wertenbroek M, Wutzler S, Kraus R, Marzi I, Laurer H
Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany.
Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
Eur J Trauma Emerg Surg. 2014 Feb;40(1):37-43. doi: 10.1007/s00068-013-0338-7. Epub 2013 Nov 6.
Diagnosis of Triplane fractures remains difficult in common practice. Aim of the study was the evaluation of the fracture pattern and the benefit of cross-sectional imaging in classification of Triplane-fractures.
A total of 27 pediatric patients treated for ankle fractures were identified from patient charts. Radiographic images of epiphyseal fractures (X-rays and additional cross-sectional imaging) were blinded evaluated by 13 observers to answer a specific questionnaire regarding type or fracture and treatment suggestion.
There were seven Triplane-I and eight Triplane-II fractures. The other physeal ankle fracture group consisted of four patients with a Twoplane-fracture, five Salter-and-Harris (SH) II, one SH-III, and two SH-IV fracture. Accuracy of classification improved considerably depending on the experience of the observer in pediatric trauma care. Surgeons specialized in pediatric trauma care classified correctly with conventional X-rays in 48.1 % of all cases presented versus 31.5 % appropriate diagnosis by younger fellows. Accuracy in exact specification of Triplane-fractures was comparable lesser in younger fellows (31.1 vs. 22 %). Cross-sectional imaging improved classification of all fractures in both groups (75.6 % specialized vs. 47.3 % non specialized). Whereas availability of cross-sectional imaging improved treatment recommendation in specialized surgeons this benefit was not detectable for the doctors without specialization. Evaluation of fracture pattern showed a relatively stereotypical fracture pattern in Triplane-II fractures, whereas Triplane-I fractures were more variable.
The additional information of cross-sectional imaging seems helpful for any physician in finding the right classification of a pediatric ankle fracture. However, the additive information appears especially viable for experienced surgeons to suggest the appropriate treatment.
在日常临床实践中，三平面骨折的诊断仍然具有挑战性。本研究旨在评估骨折类型以及横断面成像在三平面骨折分类中的作用。
从患者病历中确定了27例接受踝关节骨折治疗的儿科患者。13名观察者对骨骺骨折的影像学图像（X线及其他横断面成像）进行盲法评估，以回答一份关于骨折类型及治疗建议的特定问卷。
共有7例三平面I型骨折和8例三平面II型骨折。其他骨骺踝关节骨折组包括4例双平面骨折患者、5例Salter-Harris（SH）II型骨折、1例SH-III型骨折和2例SH-IV型骨折。分类的准确性很大程度上取决于观察者在儿科创伤治疗方面的经验。专门从事儿科创伤治疗的外科医生对所有病例使用传统X线正确分类的比例为48.1%，而年轻医生的正确诊断率为31.5%。年轻医生对三平面骨折准确分型的准确率相对较低（31.1%对22%）。横断面成像提高了两组所有骨折的分类准确率（专科医生为75.6%，非专科医生为47.3%）。虽然横断面成像的应用提高了专科医生的治疗建议水平，但对于非专科医生来说，这种优势并不明显。骨折类型评估显示，三平面II型骨折的骨折类型相对较为典型，而三平面I型骨折则更具多样性。
横断面成像提供的额外信息似乎有助于任何医生对儿童踝关节骨折进行正确分类。然而，这些额外信息对于经验丰富的外科医生提出合适的治疗建议似乎尤其有用。
