Stenroos A, Laaksonen T, Nietosvaara N, Jalkanen J, Nietosvaara Y
1 Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland.
2 Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Scand J Surg. 2018 Sep;107(3):269-274. doi: 10.1177/1457496917748227. Epub 2018 Jan 1.
Internal fixation of pediatric tibia shaft fractures has become increasingly popular despite the fact that non-operative treatment results in satisfactory outcome with few exceptions. Indications for surgery and benefits of internal fixation are however still debatable.
All 296 less than 16-year-old patients treated for a tibia shaft fracture between 2010 and 2015 in two of the five university hospitals in Finland were included in the study. Patient data were analyzed in three treatment groups: cast immobilization in emergency department, manipulation under anesthesia, and operative treatment. Incidence of operative treatment of pediatric tibia shaft fractures was calculated in the cities of Helsinki and Kuopio.
A total of 143 (47.3%) children's tibia shaft fractures were treated with casting in emergency department, 71 (22.3%) with manipulation under anesthesia, and 82 (30.4%) with surgery. Mean age of the patients in these treatment groups was 6.2, 8.7, and 12.7 years. Fibula was intact in 89%, 51%, and 27% of the patients, respectively. All 6 patients with multiple fractures and 16 of 18 patients with open fractures were treated operatively. In eight patients, primary non-operative treatment was converted to internal fixation. Operatively treated patients with isolated closed fractures were more likely to have a fibula fracture (46/66 vs 52/214, p < 0.001), be older in age (13.08 ± 2.4 vs 6.4 ± 3.7, p < 0.001), and have more primary angulation (6.9 ± 5.8 vs 0.48 ± 3.1, p < 0.001). Re-operations were done to eight and corrective osteotomy to two operatively treated children.
Operative treatment of a pediatric tibia shaft fracture is currently nearly a rule in patients with open or multiple fractures. Surgical treatment of closed tibia shaft fractures is based on surgeon's personal preference, type of fracture and age of the patient.
尽管非手术治疗在极少数情况下效果欠佳，但小儿胫骨干骨折的内固定治疗已越来越普遍。然而，手术指征及内固定的益处仍存在争议。
纳入2010年至2015年期间芬兰五所大学医院中两所医院收治的所有296例16岁以下胫骨干骨折患者。患者数据在三个治疗组中进行分析：急诊科石膏固定、麻醉下手法复位及手术治疗。计算赫尔辛基和库奥皮奥两市小儿胫骨干骨折的手术治疗发生率。
共有143例（47.3%）儿童胫骨干骨折在急诊科接受石膏固定治疗，71例（22.3%）接受麻醉下手法复位，82例（30.4%）接受手术治疗。这些治疗组患者的平均年龄分别为6.2岁、8.7岁和12.7岁。腓骨完整的患者比例分别为89%、51%和27%。所有6例多发骨折患者及18例开放性骨折患者中的16例接受了手术治疗。8例患者最初的非手术治疗转为内固定。接受手术治疗的单纯闭合性骨折患者更易发生腓骨骨折（46/66比52/214，p<0.001）、年龄更大（13.08±2.4比6.4±3.7，p<0.001）且初始成角更大（6.9±5.8比0.48±3.1，p<0.001）。8例接受手术治疗的儿童进行了再次手术，2例进行了截骨矫正术。
目前，小儿开放性或多发骨折患者的胫骨干骨折手术治疗几乎已成常规。闭合性胫骨干骨折的手术治疗取决于外科医生的个人偏好、骨折类型及患者年龄。
