Department of Physical Medicine and Rehabilitation.
Department of Physical Medicine and Rehabilitation, University of Toronto, Toronto.
J Pediatr Orthop. 2021 Mar 1;41(3):e272-e278. doi: 10.1097/BPO.0000000000001750.
Effective options exist for acute nonoperative management of anterior tibial spine fractures, yet there exists a paucity of literature describing long-term outcomes for these patients. This systematic review thus aims to consolidate management strategies and complications for patients with nonoperative anterior tibial spine fractures. In accordance with PRISMA guidelines, 5 databases (CINAHL, MEDLINE, EMBASE, Cochrane, and Pubmed) were searched and screened in duplicate. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Of 485 studies identified in the initial search, a total of 18 studies involving 369 patients were eligible for this review. These were stratified into 173 type I, 124 type II, and 72 type III injuries as described by Meyers and McKeever. All patients were treated with knee immobilization in either full extension or slight flexion, with possible closed reduction and/or aspiration of hemarthrosis. Complications at final follow-up comprised 33.9% of patients with persistent stiffness, 19.4% persistent instability, 11.1% mechanical symptoms, 6.37 delayed anterior cruciate ligament reconstruction, 4.9% delayed operative intervention for other complications, and 1.9% extension impingement. Given the lack of comparative studies in this review, definitive conclusions for nonoperative management are difficult to establish on the basis of the current body of literature alone. A modestly higher rate of arthrofibrosis and persistent laxity are seen in higher-grade injuries, however, only a minority of studies stratified complications by Meyers and McKeever classification in this review. A better understanding of variables in treatment decision making require further prospective study focused on the collection of functional and patient-reported outcome measures, whereas also further delineating complications by injury severity.
对于胫骨前棘骨折的非手术急性治疗，存在有效的选择方法，但关于这些患者的长期结果的文献却很少。因此，本系统回顾旨在整合非手术治疗胫骨前棘骨折患者的管理策略和并发症。根据 PRISMA 指南，对 5 个数据库（CINAHL、MEDLINE、EMBASE、Cochrane 和 Pubmed）进行了重复搜索和筛选。使用非随机研究方法学指数（MINORS）标准进行质量评估。在最初的搜索中确定了 485 项研究，共有 18 项研究涉及 369 名患者符合本综述的纳入标准。这些研究根据 Meyers 和 McKeever 的分类分为 173 型 I、124 型 II 和 72 型 III 损伤。所有患者均采用膝关节伸直或轻度屈曲固定治疗，可能进行闭合复位和/或关节内积血抽吸。最终随访时的并发症包括 33.9%的患者存在持续性僵硬，19.4%的患者存在持续性不稳定，11.1%的患者存在机械症状，6.37%的患者需要延迟前交叉韧带重建，4.9%的患者需要延迟手术干预其他并发症，1.9%的患者存在伸展撞击。鉴于本综述中缺乏比较研究，因此仅根据目前的文献资料，难以确定非手术治疗的明确结论。然而，在较高等级的损伤中，出现了更高的关节纤维化和持续性松弛的情况，只是在本综述中，少数研究根据 Meyers 和 McKeever 分类对并发症进行了分层。需要进一步的前瞻性研究来更好地了解治疗决策中的变量，重点是收集功能和患者报告的结果测量，同时进一步根据损伤严重程度来确定并发症。
