Weber Birte, Kalbitz Miriam, Baur Meike, Braun Christian Karl, Zwingmann Jörn, Pressmar Jochen
Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany.
Department of Trauma, Hand and Reconstructive Surgery, Goethe University of Frankfurt, Frankfurt, Germany.
Front Pediatr. 2021 Mar 4;9:597870. doi: 10.3389/fped.2021.597870. eCollection 2021.
Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg. In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF). The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% ( = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast ( = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy. Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability.
小腿骨折是儿童期最常见的骨折之一。一般来说，小腿骨折的治疗主要是非手术治疗，需要临床和影像学检查。然而，可以观察到近年来胫骨干骨折越来越多地采用手术治疗。本研究的目的是探讨不同类型小腿骨折的治疗策略。在这项回顾性病历审查中，我们分析了2005年至2017年间入住创伤中心的168例小腿骨干骨折患儿。骨折根据AO儿童长骨骨折综合分类（AO-PCCF）进行分类。基于AO-PCCF分类的骨折频率如下：胫骨单纯斜形骨折（43.5%，n = 73），其中32例为幼儿骨折；胫骨多段斜形骨折占14.3%（n = 24）；胫骨和腓骨均为单纯斜形骨折18例（10.7%）。大多数儿童骨折采用石膏保守治疗（n = 125）。37例患者接受了弹性髓内钉固定（ECMES），3例患者采用外固定器治疗，3例骨折采用钢板内固定术固定。与接受ECMES治疗（平均年龄10.2岁）或钢板内固定术/外固定器（EF）治疗（平均年龄11.3岁）的患者相比，保守治疗的患者明显更年轻（平均年龄6.0岁），即使排除幼儿骨折（平均年龄2.0岁）也是如此（平均年龄7.4岁）。与保守治疗相比，接受ECMES治疗的患者完全负重时间和住院时间没有差异，尽管接受ECMES治疗的骨折显示出更多的不稳定性。与保守治疗相比，接受ECMES治疗的患者骨折愈合时间明显更长。小腿骨折的儿科患者（≤4岁）最常表现为胫骨单纯斜形骨折，其中一半为幼儿骨折，主要采用保守治疗。总体而言，髓内钉固定（ECMES）的骨折愈合时间比保守治疗更长。然而，两组的完全负重时间和石膏固定时间相同，尽管接受ECMES治疗的骨折显示出更多的不稳定性。
