Çiçekli Özgür, Özdemir Güzelali, Uysal Mustafa, Biçici Vedat, Bingöl İzzet
Department of Orthopaedic Surgery and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey.
Department of Orthopaedic Surgery and Traumatology, Numune Training and Research Hospital, Ankara, Turkey.
Springerplus. 2016 Nov 7;5(1):1925. doi: 10.1186/s40064-016-3623-1. eCollection 2016.
Ankle injuries are among the most common injuries in children. The aim of this study was to compare the efficacies of two percutaneous fixation methods after closed reduction in physeal ankle fractures.
We reviewed the cases of 24 patients with a mean age of 12.29 years; 16 were male, and 8 were female. Only patients with fractures of Salter-Harris types 2, 3, and 4 with displacements greater than 2 mm were included in the study. Patients were treated with closed reduction manipulation and percutaneous screw fixation. For each patient, either cannulated or headless full threaded compressive screws were used for percutaneous fixation. Radiological and clinical healing time, range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and physeal arrest were then measured.
The mean follow-up time was 13 months. The mean time until cast removal was 3.5 weeks (range 2-5). A full ROM was achieved at an average of 5.7 weeks postoperatively (range 4-8). The radiologic healing time was 6.1 weeks (range 4-7). The patients' clinical healing time averaged 6.8 weeks (range 5-8). Differences in radiologic healing time (p = 0.487), clinical healing time (p = 0.192), AOFAS score (p = 0.467), and complication rate (p = 0.519) between patients who received the headless compressive screw and those who received the cannulated screw for fixation were not statistically significant.
We demonstrate good clinical results with closed reduction and the percutaneous screw fixation method. Both cannulated and headless compressive screws can be used safely as a treatment method in physeal ankle fractures.
踝关节损伤是儿童最常见的损伤之一。本研究的目的是比较闭合复位后两种经皮固定方法治疗儿童踝关节骨骺骨折的疗效。
我们回顾了24例平均年龄为12.29岁的患者病例；其中男性16例，女性8例。本研究仅纳入Salter-Harris 2型、3型和4型骨折且移位大于2mm的患者。患者接受闭合复位手法及经皮螺钉固定治疗。对于每位患者，经皮固定采用空心螺钉或无头全螺纹加压螺钉。然后测量影像学和临床愈合时间、活动范围（ROM）、美国矫形足踝协会（AOFAS）评分以及骨骺阻滞情况。
平均随访时间为13个月。平均拆除石膏时间为3.5周（范围2 - 5周）。术后平均5.7周（范围4 - 8周）达到完全活动范围。影像学愈合时间为6.1周（范围4 - 7周）。患者临床愈合时间平均为6.8周（范围5 - 8周）。接受无头加压螺钉固定和接受空心螺钉固定的患者在影像学愈合时间（p = 0.487）、临床愈合时间（p = 0.192）、AOFAS评分（p = 0.467）及并发症发生率（p = 0.519）方面的差异无统计学意义。
我们证明了闭合复位及经皮螺钉固定方法具有良好的临床效果。空心螺钉和无头加压螺钉均可安全地用于治疗儿童踝关节骨骺骨折。
