Rogers Gareth P, Tan Hiang B, Foster Patrick, Harwood Paul
Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, UK.
Trauma and Orthopaedics Department, University of Leeds, Faculty of Medicine and Health, UK.
Strategies Trauma Limb Reconstr. 2019 Jan-Apr;14(1):20-24. doi: 10.5005/jp-journals-10080-1421.
Segmental fractures in the juvenile distal tibia with physeal involvement present specific challenges. Injury to the growth plate may be overlooked, potentially resulting in late sequelae. Fracture stabilization can be complex. Previous reports of management of such an injury are by open reduction and internal fixation. This study reviews the management and outcome of a group of such patients treated with Ilizarov external fixators.
Patients aged 16 or younger treated in our unit between March 2013 and November 2014 by Ilizarov circular fine wire fixation for tibial fractures with ipsilateral physeal injuries were identified. Retrospective collection of patient demographics, fracture classification, treatment pathways, fixation methods, postoperative follow-up, outcomes, and complications was undertaken.
Eight patients were identified; two had Gustilo and Anderson grade IIIA open injuries. All were managed definitively using an Ilizarov external fixator in combination with percutaneous screw fixation of the physeal component as required. All patients were ambulant during treatment and were allowed unrestricted weight-bearing immediately postoperative. All but one attended school. All fractures united. In follow-up, one patient had a distal tibial physeal growth arrest, but there were no other complications.
Pediatric patients with complex distal tibial fractures should be scrutinized for concomitant physeal injury. Where identified treatment, using a combination of internal fixation and an Ilizarov fixator can be considered.
Rogers GP, Tan HB, Foster P, Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method. Strategies Trauma Limb Reconstr 2019;14(1):20-24.
青少年胫骨远端涉及骨骺的节段性骨折带来了特殊挑战。生长板损伤可能被忽视，这可能会导致后期后遗症。骨折固定可能很复杂。以往关于此类损伤治疗的报道是采用切开复位内固定术。本研究回顾了一组采用伊里扎洛夫外固定器治疗的此类患者的治疗情况及结果。
确定2013年3月至2014年11月间在本单位接受伊里扎洛夫环形细钢丝固定治疗的、伴有同侧骨骺损伤的胫骨骨折且年龄在16岁及以下的患者。对患者的人口统计学资料、骨折分类、治疗途径、固定方法、术后随访、结果及并发症进行回顾性收集。
共确定8例患者；2例为 Gustilo 和 Anderson IIIA 级开放性损伤。所有患者均根据需要采用伊里扎洛夫外固定器结合骨骺部分的经皮螺钉固定进行确定性治疗。所有患者在治疗期间均可行走，术后立即允许无限制负重。除1例患者外，其余均上学。所有骨折均愈合。随访中，1例患者出现胫骨远端骨骺生长停滞，但无其他并发症。
对于患有复杂胫骨远端骨折的儿科患者，应仔细检查是否伴有骨骺损伤。若发现有损伤，可考虑采用内固定和伊里扎洛夫固定器联合治疗。
Rogers GP, Tan HB, Foster P, 采用伊里扎洛夫方法治疗涉及远端骨骺的儿童复杂胫骨干骨折。创伤肢体重建策略2019；14(1):20 - 24。
