Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, 500 University Drive, Mail Box 593, Hershey, PA 17033 United States.
Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, 500 University Drive, Mail Box 593, Hershey, PA 17033 United States.
Injury. 2020 Mar;51(3):636-641. doi: 10.1016/j.injury.2020.01.039. Epub 2020 Jan 29.
Distal Salter-Harris (SH) II fractures of the tibia are common injuries in the pediatric population. The purpose of this study is to evaluate our treatment and outcomes of SH II fractures of the distal tibia.
The study was approved by the medical school's institutional review board (IRB). Fifty-one distal tibia SH type II fractures were treated from 2003 to 2017. We performed a retrospective review of all patients. Patients with displacement less than 3 mm, on x-ray, were treated with a cast. Patients with displacement greater than or equal to 3 mm displacement were initially treated with closed reduction in the emergency department with conscious sedation. Patients were also categorized based on the mechanism of injury and complications were noted. Patients were followed for an average of 4 months (range, 4 weeks-28 months).
Fifty-one patients, 28 females and 23 males, were included in the study, with a mean age of 9.4 years (range, 13 months-13 years) at presentation. The most common mechanism of injury was participation in sports (43%). Out of the 51 patients, 45 were minimally displaced and treated with cast. Six displaced fractures were treated with closed reduction. The mean displacement in the closed reduction group at presentation was 5.7 (range, 3- 8.8) mm. Five out of 6 patients had reduction to less than 3 mm. The overall complication rate was 1 out of 51 patients, 2%. When examining displaced fractures, the complication rate was 1 out of 6 patients, 17%.
Most SH II fractures of the distal tibia are minimally displaced and do not need a reduction. 6/51 cases (12%) in the current study were displaced and were indicated for a reduction. Displacement greater than or equal to 3 mm can be treated with closed reduction followed by a cast; if closed reduction fails, open reduction is indicated. Displaced fractures have a small risk of growth arrest.
儿童中常见的胫骨远端 Salter-Harris（SH）II 型骨折。本研究旨在评估我们对胫骨远端 SH II 型骨折的治疗效果和结果。
该研究经医学院机构审查委员会（IRB）批准。2003 年至 2017 年共治疗 51 例胫骨远端 SH II 型骨折患者。对所有患者进行回顾性研究。X 线片显示移位小于 3mm 的患者采用石膏固定。对于有大于或等于 3mm 移位的患者，首先在急诊科进行闭合复位，辅以清醒镇静。根据损伤机制对患者进行分类，并注意并发症。患者平均随访 4 个月（4 周-28 个月）。
研究纳入 51 例患者，女 28 例，男 23 例，平均年龄 9.4 岁（13 个月-13 岁）。最常见的损伤机制是运动（43%）。51 例患者中，45 例为轻度移位，采用石膏固定。6 例移位骨折采用闭合复位。闭合复位组患者的平均初始移位为 5.7mm（范围为 3-8.8mm）。5 例患者复位后小于 3mm。总体并发症发生率为 51 例患者中的 1 例，2%。检查移位骨折时，并发症发生率为 6 例患者中的 1 例，17%。
大多数胫骨远端 SH II 型骨折为轻度移位，无需复位。本研究中 6/51 例（12%）患者发生移位，需要复位。大于或等于 3mm 的移位可采用闭合复位加石膏固定；若闭合复位失败，则采用切开复位。移位骨折有发生生长停滞的风险较小。
