Scrimshire A B, Gawad M, Davies R, George H
Trauma and Orthopaedic Registrar, Northern Deanery, United Kingdom.
Trauma and Orthopaedic Core Surgical Trainee, North West Deanery, United Kingdom.
Injury. 2018 Feb;49(2):437-442. doi: 10.1016/j.injury.2017.11.013. Epub 2017 Nov 16.
Paediatric fractures of the tibial spine are relatively rare and controversy remains around how these injuries are best managed (Gans et al., 2014; Hargrove et al., 2004). Consequently most non-specialised paediatric units have limited experience of managing these injuries. This study aims to review the management and outcomes of isolated paediatric tibial spine fractures in a tertiary paediatric orthopaedic centre between 2008 and 2016. Data were collected on patient demographics, mechanism of injury, imaging, Meyers and McKeever grade of injury (Meyers and McKeever), management and outcomes, including Cincinnati and Lysholm-Tegner knee scores at a mean of 36 months post-operatively. 40 patients were included, 21 were male and the mean age was 11.8 years. 3 cases were Meyers and McKeever type I, 13 were type II and 24 were type III. 30 underwent operative management comprising of open reduction and single screw fixation, with or without a washer. 9 patients underwent subsequent metalwork removal at a mean of 10 months post-operatively. 10 underwent non-operative management, consisting of cast immobilisation and bracing. 33 patients (83%) were available for follow up. No statistically significant differences were seen in either outcome score between those treated operatively or non-operatively, or between different grades of injury, or if metalwork were removed or not. Our study shows good functional outcomes following paediatric tibial spine fracture. We advocate the use of CT to assess fracture displacement to help guide management. We have shown type I and reducible type II injuries can successfully be managed conservatively and non-reducible type II and type III injuries can be successfully treated with open reduction and single screw fixation. In our experience post-operative knee stiffness can persist for up to 6 months but generally improves. Metalwork removal was only indicated if the patient had on going stiffness after this time or if they had on going pain.
小儿胫骨棘骨折相对少见，对于如何最佳处理此类损伤仍存在争议（甘斯等人，2014年；哈格罗夫等人，2004年）。因此，大多数非专科儿科单位处理此类损伤的经验有限。本研究旨在回顾2008年至2016年期间在一家三级儿科骨科中心对孤立性小儿胫骨棘骨折的处理及结果。收集了患者的人口统计学数据、损伤机制、影像学检查、迈尔斯和麦基弗损伤分级（迈尔斯和麦基弗）、处理方式及结果，包括术后平均36个月时的辛辛那提和利绍姆 - 特格纳膝关节评分。纳入40例患者，其中男性21例，平均年龄11.8岁。3例为迈尔斯和麦基弗I型，13例为II型，24例为III型。30例行手术治疗，包括切开复位及单螺钉固定，可带或不带垫圈。9例患者术后平均10个月接受了内固定取出术。10例行非手术治疗，包括石膏固定和支具固定。33例患者（83%）接受了随访。手术治疗与非手术治疗患者之间、不同损伤分级之间以及是否取出内固定之间，在任何一项结果评分上均未观察到统计学显著差异。我们的研究表明小儿胫骨棘骨折后功能预后良好。我们主张使用CT评估骨折移位情况以帮助指导治疗。我们已经表明I型和可复位的II型损伤可以成功地保守治疗，而不可复位的II型和III型损伤可以通过切开复位及单螺钉固定成功治疗。根据我们的经验，术后膝关节僵硬可持续长达6个月，但一般会有所改善。仅在患者在此之后仍持续僵硬或仍有疼痛时才考虑取出内固定。
