Department of Orthopaedic Surgery, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University.
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Curr Opin Pediatr. 2019 Feb;31(1):92-102. doi: 10.1097/MOP.0000000000000704.
To describe surgical treatment options for pediatric tibial shaft fractures which are the third most common pediatric long bone fracture. Management of these injuries is dictated by fracture location, fracture pattern, associated injuries, skeletal maturity, and other patient-specific factors. Although most pediatric tibial shaft fractures can be treated nonoperatively, this review provides an update on surgical treatment options when operative intervention is indicated.
Advances in surgical implants and techniques affords a wide range of options for the surgical treatment of pediatric tibial shaft fractures. Flexible intramedullary nailing is gaining wide adoption for acute surgical treatment. Recent studies support cross-sectional imaging for further evaluation and scrutiny of fracture patterns suspicious for intraphyseal or intra-articular extension. Grade I open tibial shaft fractures may be safely treated with irrigation and debridement in the emergency department; however, no high-level comparative studies have been performed to make any definitive conclusions regarding the effectiveness of this treatment strategy.
Tibial shaft fractures are common injuries in pediatric patients. Management is dictated by fracture location, fracture pattern, associated injuries, patient age, and other patient-specific factors. Surgical intervention is indicated for fractures that are open, irreducible, have failed nonoperative management, are associated with compartment syndrome, or in the multiply injured patient. Surgical treatment options include flexible intramedullary nailing, plate osteosynthesis, external fixation, and rigid intramedullary nailing. Recent literature has shown increased rates of flexible intramedullary nailing. All operative and nonoperative management options can result in complications including compartment syndrome, infection, delayed union, nonunion, malunion, limb length discrepancy, and symptomatic hardware. Most pediatric patients go on to uneventful union with excellent final outcomes and return to full activities.
描述儿童胫骨骨干骨折的手术治疗选择，这是儿童最常见的第三长骨骨折。这些损伤的处理取决于骨折部位、骨折类型、相关损伤、骨骼成熟度和其他患者特定因素。尽管大多数儿童胫骨骨干骨折可以非手术治疗，但当需要手术干预时，本综述提供了手术治疗选择的最新信息。
手术植入物和技术的进步为儿童胫骨骨干骨折的手术治疗提供了广泛的选择。弹性髓内钉越来越多地用于急性手术治疗。最近的研究支持对骨折模式进行横断面成像，以进一步评估和检查疑似骺内或关节内延伸的骨折。I 级开放性胫骨骨干骨折在急诊科可安全地进行冲洗和清创术治疗；然而，没有进行任何高级别的比较研究来对这种治疗策略的有效性做出任何明确的结论。
胫骨骨干骨折是儿童患者常见的损伤。治疗取决于骨折部位、骨折类型、相关损伤、患者年龄和其他患者特定因素。手术干预适用于开放性、不可复位性、非手术治疗失败、合并骨筋膜室综合征或多发伤的骨折。手术治疗选择包括弹性髓内钉、钢板内固定、外固定和刚性髓内钉。最近的文献显示弹性髓内钉的使用率增加。所有手术和非手术治疗选择都可能导致并发症，包括骨筋膜室综合征、感染、延迟愈合、不愈合、畸形愈合、肢体长度差异和有症状的内固定物。大多数儿童患者最终愈合良好，结局良好，可完全恢复正常活动。
