青少年移位性胫骨远端干骺端骨折的骨折模式和骨膜嵌顿：一项磁共振成像研究。

Fracture Pattern and Periosteal Entrapment in Adolescent Displaced Distal Tibial Physeal Fractures: A Magnetic Resonance Imaging Study.

机构信息

Nursing Economics and Policy, College of Nursing, Seoul National University, Seoul, Republic of Korea.

Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.

出版信息

J Orthop Trauma. 2019 May;33(5):e196-e202. doi: 10.1097/BOT.0000000000001421.

DOI:10.1097/BOT.0000000000001421

PMID:30633082

Abstract

OBJECTIVES

To investigate the fracture pattern and periosteal entrapment in adolescent distal tibial physeal fractures.

DESIGN

Retrospective case series.

SETTING

Level I academic trauma center.

PATIENTS/PARTICIPANTS: Fifty patients (10-16 years of age) with displaced Salter-Harris type II, III, or IV distal tibial physeal fractures were retrospectively reviewed.

INTERVENTION

Periosteal involvement, fracture pattern.

MAIN OUTCOME MEASUREMENTS

We investigated the incidence and location of periosteal entrapment in those fractures and the angle of the fracture plane of metaphyseal fragments on axial plane by using magnetic resonance imaging.

RESULTS

Of the 15 type II, 12 type III (4 malleolar and 8 Tillaux), and 23 type IV (2 malleolar and 21 triplane) fractures, 72.0% (36/50) presented with periosteal entrapment. Among all type II and triplane fractures, periosteal entrapment was observed in the anterolateral corner when there was any displacement on that corner. By contrast, only 1 of 8 Tillaux fractures presented with periosteal entrapment. In almost all supinated foot injuries of type II and triplane fractures, the metaphyseal fracture line was parallel to the intermalleolar axis on axial plane.

CONCLUSIONS

Salter-Harris type II and triplane fractures have a high risk of periosteal entrapment especially in the anterolateral corner. Therefore, even without preoperative magnetic resonance imaging, surgical repositioning of entrapped periosteum should be considered after failed closed reduction. In cases of supinated foot injuries of type II or triplane fractures requiring surgical fixation, a metaphyseal fracture plane parallel to the oblique coronal plane connecting the medial and lateral malleoli may assist surgeons in achieving appropriate metaphyseal fixation.

LEVEL OF EVIDENCE

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

研究青少年胫骨远端骺板骨折的骨折模式和骨膜嵌顿。

设计

回顾性病例系列。

地点

一级学术创伤中心。

患者/参与者：回顾性分析 50 例（10-16 岁）移位性 Salter-Harris Ⅱ型、Ⅲ型或Ⅳ型胫骨远端骺板骨折患者。

干预措施

骨膜受累，骨折模式。

主要观察指标

我们通过磁共振成像（MRI）研究了这些骨折中骨膜嵌顿的发生率和位置，以及骺端碎片在轴位平面上的骨折平面角度。

结果

15 例Ⅱ型、12 例Ⅲ型（4 例外踝，8 例Tillaux）和 23 例Ⅳ型（2 例外踝，21 例三平面）骨折中，72.0%（36/50）存在骨膜嵌顿。在外踝有任何移位的所有Ⅱ型和三平面骨折中，前外侧角都存在骨膜嵌顿。相比之下，只有 8 例 Tillaux 骨折中的 1 例出现骨膜嵌顿。在几乎所有旋后足损伤的Ⅱ型和三平面骨折中，骺端骨折线在轴位平面上与内、外踝间轴平行。