Kruppa Christiane, Snoap Tyler, Sietsema Debra L, Schildhauer Thomas A, Dudda Marcel, Jones Clifford B
Surgeon, Department of General and Trauma Surgery, BG University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany; Research Fellow, Grand Rapids Medical Education Partners, Grand Rapids, MI.
Medical Student, Michigan State University College of Human Medicine, Grand Rapids, MI.
J Foot Ankle Surg. 2018 May-Jun;57(3):471-477. doi: 10.1053/j.jfas.2017.10.031. Epub 2018 Mar 2.
The outcomes of pediatric talus fractures have been minimally reported in published studies. The purpose of the present retrospective study was to determine the clinical and radiographic outcomes after talus fractures in pediatric and adolescent patients and to define the differences among the different age groups in this population. A total of 52 children and adolescents (54 fractures) with 24 type 1 (44.44%), 13 type 2 (24.07%), 8 type 3 (14.81%), and 9 type 4 (16.67%) Marti-Weber fractures were considered. Of the 52 patients, 19 (35.19%; 21 talus fractures) with follow-up data available for >12 months were included in the final study population. Of the 21 fractures, 9 (42.86 %) were type 1, 4 (19.05%) were type 2, 1 (4.76%) was type 3, and 7 (33.33%) were type 4. The mean patient age was 14.7 (range 4 to 18) years. The patients were divided into 3 age groups: group 1, age ≤11.9 years; group 2, age 12.0 to 15.8 years; and group 3, age 16.1 to 18.0 years. Of the 21 fractures, 3 (14.29%) were treated nonoperatively and 18 (85.71%) operatively. The overall mean follow-up duration was 40.3 (range 14 to 95) months. The outcomes of interest included fracture nonunion, talar avascular necrosis, ankle range of motion, pain, arthrosis, and arthrodesis. After treatment, the mean ankle range of motion was 20° (range 0° to 35°) of dorsiflexion and 40° (range 0° to 45°) of plantarflexion. Complications included persistent pain in 10 fractures (47.62%), 3 cases of nonunion (14.29%), 3 cases of avascular necrosis (14.29%; of which, 1 [4.76%] required ankle and subtalar fusion), and arthrosis developing in ≥1 surrounding joint in 12 fractures (57.14%). Of the 12 fractures in group 3, 9 (75.00%) developed arthrosis and 2 (16.67%) subsequently required arthrodesis. Our observations suggest that the incidence of displaced talus fractures, as well as complications, increases with patient age.
已发表的研究中对小儿距骨骨折的预后报道极少。本回顾性研究的目的是确定小儿及青少年患者距骨骨折后的临床和影像学预后，并明确该人群中不同年龄组之间的差异。共纳入52例儿童和青少年（54处骨折），其中24例为1型（44.44%）、13例为2型（24.07%）、8例为3型（14.81%）、9例为4型（16.67%）Marti-Weber骨折。52例患者中，19例（35.19%；21处距骨骨折）有超过12个月的随访数据，被纳入最终研究人群。21处骨折中，9例（42.86%）为1型，4例（19.05%）为2型，1例（4.76%）为3型，7例（33.33%）为4型。患者平均年龄为14.7岁（范围4至18岁）。患者被分为3个年龄组：1组，年龄≤11.9岁；2组，年龄12.0至15.8岁；3组，年龄16.1至18.0岁。21处骨折中，3例（14.29%）接受非手术治疗，18例（85.71%）接受手术治疗。总体平均随访时间为40.3个月（范围14至95个月）。关注的预后指标包括骨折不愈合、距骨缺血性坏死、踝关节活动度、疼痛、关节病和关节融合术。治疗后，踝关节平均活动度为背屈20°（范围0°至35°），跖屈40°（范围0°至45°）。并发症包括10处骨折（47.62%）持续疼痛、3例骨折不愈合（14.29%）、3例缺血性坏死（14.29%；其中1例[4.76%]需要踝关节和距下关节融合），以及12处骨折（57.14%）在≥1个周围关节出现关节病。3组的12处骨折中，9例（75.00%）出现关节病，2例（16.67%）随后需要关节融合术。我们的观察结果表明，移位距骨骨折的发生率以及并发症随着患者年龄的增加而升高。
