Department of Traumatology and Hand Surgery, Petz Aladár County Teaching Hospital, H - 9023 Győr, Vasvári Pál st. 2-4, Győr, Hungary.
Department of Traumatology and Hand Surgery, Petz Aladár County Teaching Hospital, H - 9023 Győr, Vasvári Pál st. 2-4, Győr, Hungary.
Injury. 2021 Mar;52 Suppl 1:S67-S73. doi: 10.1016/j.injury.2020.02.049. Epub 2020 Feb 18.
The first-line treatment of paediatric tibial fractures is non-operative but the number of operatively treated patients is rising. Elastic intramedullary nailing and external fixation are widely used in children while solid intramedullary nailing, the standard procedure in adults, is usually not recommended due to the open physes.
Between January 2007 and October 2017, unreamed locked solid intramedullary nailing was used in 16 cases of adolescent (mean age 13.7 ± 1.25 years) tibial diaphyseal fractures with open physes. An atypical, physeal-sparing method was used in all cases. Fourteen patients were managed by the standard implant used routinely in adult trauma care. Two patients were treated by a special nail, modified specifically for paediatric care.
Good functional healing was found in all cases treated by the atypical method. Partial weight bearing began immediately after surgery in 38% of the cases. Full weight bearing was allowed 7.3 ± 2.4 weeks postoperatively. The average time to fracture union was 11.5 ± 2.9 weeks. Superficial infection and wound healing complication occurred in 3 cases. Deep infection, compartment syndrome or other bone related complications did not arise.
The treatment of tibial fractures in adolescents is challenging due to larger body size and significant growth potential. The atypical intramedullary nailing method presented in this study can provide optimal functional healing, early mobilization and weight bearing while completely sparing the physis. This method can serve as an alternative in the operative treatment of adolescent tibial diaphyseal fractures.
儿童胫骨骨折的一线治疗是非手术治疗，但手术治疗的患者数量正在增加。弹性髓内钉和外固定器在儿童中广泛应用，而实心髓内钉，成人的标准手术方法，由于骺板未闭合通常不被推荐。
2007 年 1 月至 2017 年 10 月，采用未扩髓锁定实心髓内钉治疗 16 例青少年（平均年龄 13.7±1.25 岁）胫骨骨干骺端骨折。所有病例均采用非典型、骺板保护方法。14 例患者采用成人创伤常规使用的标准植入物治疗。2 例患者采用专门为儿科护理定制的特殊钉子治疗。
采用非典型方法治疗的所有病例均获得良好的功能愈合。38%的病例术后立即部分负重，7.3±2.4 周后可完全负重。骨折愈合的平均时间为 11.5±2.9 周。3 例发生浅表感染和伤口愈合并发症。无深部感染、骨筋膜室综合征或其他骨相关并发症。
由于体型较大和生长潜力较大，青少年胫骨骨折的治疗具有挑战性。本研究中介绍的非典型髓内钉方法可以提供最佳的功能愈合、早期活动和负重，同时完全保护骺板。该方法可作为青少年胫骨骨干骨折手术治疗的一种替代方法。
