From the University of Texas Health Science Center at San Antonio, San Anotonio, TX.
J Am Acad Orthop Surg. 2019 Oct 15;27(20):769-778. doi: 10.5435/JAAOS-D-17-00819.
Diaphyseal tibia fractures in the pediatric population have dynamic treatment strategies that depend on injury pattern, mechanism, patient skeletal maturity and size. Treatment strategies include closed reduction and cast immobilization, flexible nails, uniplanar or multiplanar external fixation or plate osteosynthesis. Accepted parameters for sagittal and coronal alignment vary based on age and potential for remodeling, although all fractures should have minimal rotational malalignment and less than 1 cm of shortening. Stable union generally occurs in 3 to 4 weeks for the common toddler's fracture and 6 to 8 weeks in other fracture patterns. Complications such as compartment syndrome are possible with both open and closed injuries, and nonunions, although rare, are more common in patients treated with external fixation or flexible nailing. Overall, treatment should be predicated on a full evaluation of the patient, fracture, local soft tissues, and any concomitant injuries.
儿童骨干骨折的治疗策略具有动态性，取决于损伤模式、机制、患者的骨骼成熟度和大小。治疗策略包括闭合复位和石膏固定、弹性钉、单平面或多平面外固定或钢板内固定。矢状面和冠状面的可接受对线参数因年龄和重塑潜力而异，但所有骨折都应具有最小的旋转对线不良和小于 1 厘米的缩短。常见的幼儿骨折一般在 3 至 4 周内愈合，其他骨折模式则需要 6 至 8 周。无论是开放性还是闭合性损伤，都可能发生筋膜间室综合征等并发症，虽然不常见，但在接受外固定或弹性钉治疗的患者中更为常见。总体而言，治疗应基于对患者、骨折、局部软组织和任何伴随损伤的全面评估。
