Yang Brian W, Shore Benjamin J, Rademacher Emily, May Collin, Watkins Colyn J, Glotzbecker Michael P
Department of Orthopedic Surgery, Harvard Medical School.
Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
J Pediatr Orthop. 2019 Jul;39(6):e417-e421. doi: 10.1097/BPO.0000000000001354.
There has been little investigation into the epidemiology of Cozen's phenomenon, genu valgum as a complication of proximal tibial metaphysis fractures. In this study, we present a large case series of proximal tibia fractures in children to describe the prevalence, epidemiology, and characteristics associated with Cozen's phenomenon following proximal tibial fracture in children.
We searched the orthopedic database at our institution for all patients aged 1 to 8 years old with proximal tibia fractures presenting for initial fracture management between January 1, 2014 and December 31, 2017. Demographic data, mechanism of injury, fracture characteristics, and the presence of a concurrent fibula fracture were determined from the medical records. Initial and follow-up valgus angulation was measured as the angle between a line perpendicular to the proximal tibial physis and a line drawn along the axis of the tibia. Differences in the rate of valgus angulation by mechanism of injury and fracture type were compared.
In total, 181 fractures in 181 patients were included in our study (98 male, 83 female). The average age at injury was 4.55 years (range, 1.02 to 7.95 y); 140 patients (77.3%, 140/181) had initial valgus angulation of <4 degrees; 20 of these patients (14.3%, 20/140) developed angulation of at least 4 degrees at some point during follow-up at an average of 0.8 months (range, 0.2 to 1.9 mo); 4 patients (20.0%, 4/20) with <4 degrees of initial angulation had persistent valgus angulation of 5 degrees at latest follow-up. Two of these patients were not scheduled to return because the provider did not determine the valgus angulation to be clinically meaningful. The 2 other patients were asymptomatic and continued to receive nonoperative management. No patients in our series required surgical correction of valgus deformity.
Cozen's phenomenon is an uncommon complication of proximal tibial metaphysis fractures. Eliminating unnecessary radiographs and clinical visits for our pediatric trauma patients will improve the quality and value of care delivery.
Level IV.
作为胫骨近端干骺端骨折并发症的膝外翻（科曾现象）的流行病学研究较少。在本研究中，我们展示了一系列大量儿童胫骨近端骨折病例，以描述儿童胫骨近端骨折后科曾现象的患病率、流行病学及相关特征。
我们在本机构的骨科数据库中搜索了2014年1月1日至2017年12月31日期间因初次骨折治疗而就诊的所有1至8岁胫骨近端骨折患者。从病历中确定人口统计学数据、损伤机制、骨折特征以及是否存在并发腓骨骨折。初始和随访时的外翻角度测量为垂直于胫骨近端骨骺的线与沿胫骨轴线绘制的线之间的夹角。比较不同损伤机制和骨折类型导致的外翻角度发生率差异。
我们的研究共纳入181例患者的181处骨折（男性98例，女性83例）。平均受伤年龄为4.55岁（范围1.02至7.95岁）；140例患者（77.3%，140/181）初始外翻角度<4度；其中20例患者（14.3%，20/140）在随访期间的某个时间点外翻角度至少增加了4度，平均为0.8个月（范围0.2至1.9个月）；4例初始角度<4度的患者（20.0%，4/20）在最新随访时持续存在5度的外翻角度。其中2例患者未安排复诊，因为医生认为外翻角度在临床上无意义。另外2例患者无症状，继续接受非手术治疗。我们系列研究中没有患者需要手术矫正外翻畸形。
科曾现象是胫骨近端干骺端骨折的一种罕见并发症。减少对小儿创伤患者不必要的X线检查和临床复诊将提高医疗服务的质量和价值。
四级。
