Tak Sameem, Qureshi Mobeen K, Ackland James A, Arshad Rizwan, Salim Javed
Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, GBR.
Trauma and Orthopaedics, East Lancashire NHS Hospitals, Blackburn, GBR.
Cureus. 2021 Jan 22;13(1):e12860. doi: 10.7759/cureus.12860.
The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are transitioning to skeletal maturity. Owing to its rarity, the optimal management strategy for this fracture is not well-described. The aim of this review was to assess the outcomes of operatively and nonoperatively managed displaced adolescent Tillaux fractures. We analysed articles from The Cochrane Library, PubMed, MEDLINE, and EMBASE databases that met our predetermined inclusion and exclusion criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. A descriptive data analysis was performed. A total of 461 articles were identified from the data search, of which 13 articles were included for full-text analysis. Five of these studies reported recognised patient outcome measures and the remaining eight reported on radiographic follow-up. The reported studies included a total of 114 patients with Tillaux fractures; 58.8% of patients were female and 34.2% were male. Mean ages ranged from 12.5 to 15 years, with the youngest patient being 12 years old and the oldest 17 years old. Overall mean follow-up was 42.8 months. Of the patients, 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically. The remainder were treated nonoperatively. Outcome measures were excellent for all patients irrespective of operative management choice. Follow-up radiographic deformity was only evident in Tillaux fractures that were managed nonoperatively; deformity included poor joint congruity, angular deformity, and tibial shortening. These nonoperative patients have a residual fracture displacement of 2 mm. There were no reported instances of premature physeal closure for any patient. This review shows that excellent patient outcomes have been reported for different methods of operative fixation, however, study sizes are small and data is sparse. Further robust comparative studies are required to identify definitive conclusions. The use of established clinical and radiographic outcome measures will help improve the quality of future studies for this relatively rare injury.
蒂洛骨折是胫骨远端前外侧骨骺的一种罕见损伤。它发生在青少年患者向骨骼成熟过渡的特定时间段。由于其罕见性，这种骨折的最佳治疗策略尚无详尽描述。本综述的目的是评估手术和非手术治疗移位性青少年蒂洛骨折的结果。我们根据系统评价和荟萃分析的首选报告项目（PRISMA）声明，分析了来自Cochrane图书馆、PubMed、MEDLINE和EMBASE数据库中符合我们预先设定的纳入和排除标准的文章。进行了描述性数据分析。数据检索共识别出461篇文章，其中13篇文章被纳入全文分析。这些研究中有5项报告了公认的患者结局指标，其余8项报告了影像学随访情况。报告的研究共纳入了114例蒂洛骨折患者；58.8%的患者为女性，34.2%为男性。平均年龄在12.5至15岁之间，最年轻的患者12岁，最年长的17岁。总体平均随访时间为42.8个月。其中，40.4%的患者接受了切开复位内固定（ORIF）治疗，14.9%接受了闭合复位内固定（CRIF）治疗，1.8%接受了关节镜治疗。其余患者接受非手术治疗。无论手术治疗选择如何，所有患者的结局指标都很好。随访影像学畸形仅在非手术治疗的蒂洛骨折中明显；畸形包括关节匹配不良、角畸形和胫骨缩短。这些非手术治疗的患者骨折残留移位为2毫米。没有报告任何患者出现过早骨骺闭合的情况。本综述表明，不同的手术固定方法均报告了良好的患者结局，然而，研究规模较小且数据稀少。需要进一步进行有力的比较研究以得出明确结论。使用既定的临床和影像学结局指标将有助于提高针对这种相对罕见损伤的未来研究的质量。
