Arkader Alexandre, Schur Mathew, Refakis Christian, Capraro Anthony, Woon Regina, Choi Paul
The Children's Hospital of Philadelphia, Philadelphia, PA.
Children's Hospital of Los Angeles, Los Angeles, CA.
J Pediatr Orthop. 2019 Jan;39(1):e18-e22. doi: 10.1097/BPO.0000000000001269.
Although open reduction and internal fixation are recommended for displaced tibial tubercle avulsion fractures in young athletes, whether to use unicortical or bicortical fixation is debatable. The purpose of this study is to compare the outcomes of unicortical versus bicortical fixation in a series of pediatric tibial tubercle avulsion fractures.
We reviewed a consecutive series of patients with tibial tubercle fractures treated surgically at 2 level-1 pediatric tertiary care centers over a 12.5-year period. Patients aged below 18 years of age who received surgical treatment for displaced tibial tubercle fractures with postoperative follow-up were included. Fractures were classified using a modified Ogden classification system. The relative proportion of fracture types treated and incidence of complications were compared.
The cohort included 90 fractures in 86 patients. There were 82 male and 4 female individuals; average age was 14.7 years (range, 9.0 to 18 y). In total, 87 of 90 were treated with open reduction and internal screw fixation [51 unicortical (59%), 13 mixed (15%), 23 bicortical (26%)] and 3 with percutaneous pinning. All patients were followed-up until healing and postoperative follow-up average was 8 months (range, 3 to 34 mo). There were no significant differences between the 2 groups with regard to patient age (P=0.22), patient weight (P=0.22), and activity clearance times [unicortical: 19.9 wk (range, 10.4 to 42.3 wk); bicortical: 17.7 wk (range, 12.1 to 32 wk); P=0.19]. The mixed cortical group was cleared at an average of 19.9 weeks (range, 10.6 to 29.1 wk). The relative proportion of fracture patterns treated differed negligibly between the unicortical and bicortical groups. Complications were noted in 9 of 90 procedures (10% rate); all subjects showed evidence of full radiographic healing at last follow-up.
There was no difference in outcome whether unicortical or bicortical fixation was used. All patients exhibited full healing and return to activities with very low-complication rates. The results of this study suggest the adequacy of unicortical fixation for treating tibial tubercle fractures in young athletes.
Level III-retrospective comparative study.
尽管对于年轻运动员移位的胫骨结节撕脱骨折，建议行切开复位内固定术，但使用单皮质还是双皮质固定仍存在争议。本研究的目的是比较一系列儿童胫骨结节撕脱骨折采用单皮质与双皮质固定的效果。
我们回顾了12.5年间在2家一级儿童三级护理中心接受手术治疗的胫骨结节骨折患者的连续系列病例。纳入年龄在18岁以下、因移位胫骨结节骨折接受手术治疗且术后有随访的患者。骨折采用改良的奥格登分类系统进行分类。比较治疗的骨折类型的相对比例和并发症的发生率。
该队列包括86例患者的90处骨折。男性82例，女性4例；平均年龄14.7岁（范围9.0至18岁）。90处骨折中，87处采用切开复位内螺钉固定治疗[单皮质51处（59%），混合皮质13处（15%），双皮质23处（26%）]，3处采用经皮穿针固定。所有患者均随访至骨折愈合，术后平均随访8个月（范围3至34个月）。两组在患者年龄（P = 0.22）、患者体重（P = 0.22）和活动恢复时间方面无显著差异[单皮质：19.9周（范围10.4至42.3周）；双皮质：17.7周（范围12.1至32周）；P = 0.19]。混合皮质组平均在19.9周（范围10.6至29.1周）恢复活动。单皮质组和双皮质组治疗的骨折类型相对比例差异可忽略不计。90例手术中有9例（发生率10%）出现并发症；所有受试者在最后一次随访时均显示有完全的影像学愈合证据。
使用单皮质或双皮质固定的效果无差异。所有患者均实现完全愈合并恢复活动，并发症发生率极低。本研究结果表明单皮质固定足以治疗年轻运动员的胫骨结节骨折。
三级——回顾性比较研究。
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