儿童 Salter-Harris II 踝关节骨折：骨折类型重要吗？

Salter-Harris II Ankle Fractures in Children: Does Fracture Pattern Matter?

机构信息

Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

出版信息

J Orthop Trauma. 2019 May;33(5):e190-e195. doi: 10.1097/BOT.0000000000001422.

DOI:10.1097/BOT.0000000000001422

PMID:30633083

Abstract

OBJECTIVES

To determine the correlation of Salter-Harris II fracture patterns with premature physeal closure (PPC) and resultant angular deformity of the ankle.

DESIGN

Retrospective review.

SETTING

Cincinnati Children's Hospital Medical Center (outpatient level of care).

PATIENTS/PARTICIPANTS: We searched the digital ankle radiographs taken at our institution from 2001 to 2010, identifying all skeletally immature patients with confirmed ankle fractures.

INTERVENTION

Fracture patterns were subclassified according to the Dias-Tachdjian classification system. Only patients with a minimum of 6 months of follow-up were included.

MAIN OUTCOME MEASURES

Rates of PPC, initial operative interventions, subsequent surgical interventions, and final angular deformities of the ankle in the coronal plane were recorded and considered significant if more than 10 degrees.

RESULTS

One hundred forty-one patients met our criteria. Fifty-two pronation-external rotation (PER) injuries, 35 supination-external rotation (SER) injuries, and 54 supination-plantar flexion (SPF) injuries were included. Of the PER injuries, 15 (28.8%) PPCs occurred with 6 patients having a resultant angular deformity of the ankle of at least 10 degrees at latest follow-up. Thirteen (24.1%) of the SPF patients went on to PPC with no resultant angular deformities. Of the SER injuries, 4 (11.4%) went on to PPC also with no patients having resultant angular deformities. The PER group had a statistically significantly higher rate of resultant angular deformity (P = 0.021).

CONCLUSIONS

Salter-Harris II fractures of the ankle are common in children, with fracture pattern directly related to PPC and the chance for angular deformity. PER injuries are more likely to have a PPC associated with an angular deformity compared with SER and supination-plantar flexion injuries. The odds ratio of having an angular deformity with PER injuries compared with SER and SPF injuries is 25.

SIGNIFICANCE

Fracture pattern of the ankle is related to growth disturbance, which must be taken into consideration when treating these injuries and addressed with the patient and family.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

确定 Salter-Harris II 型骨折模式与骺板早期闭合（PPC）和踝关节继发角度畸形的相关性。

设计

回顾性研究。

地点

辛辛那提儿童医院医疗中心（门诊护理水平）。

患者/参与者：我们在我院 2001 年至 2010 年的数字踝关节 X 线片中搜索，确定所有骺板未成熟且经证实存在踝关节骨折的患者。

干预措施

骨折模式根据 Dias-Tachdjian 分类系统进行亚分类。仅纳入至少随访 6 个月的患者。

主要观察指标

记录 PPC 发生率、初始手术干预、后续手术干预以及冠状面踝关节最终角度畸形，并认为如果超过 10 度，则为显著畸形。

结果

141 名患者符合我们的标准。52 例旋前外旋（PER）损伤、35 例旋后外旋（SER）损伤和 54 例旋后-跖屈（SPF）损伤。PER 损伤中，15 例（28.8%）发生 PPC，6 例患者最终出现至少 10 度的踝关节角度畸形。13 例（24.1%）SPF 患者进展为 PPC，无患者出现最终角度畸形。SER 损伤中，4 例（11.4%）进展为 PPC，也无患者出现最终角度畸形。PER 组的最终角度畸形发生率具有统计学显著差异（P = 0.021）。