St George's University Hospitals NHS Foundation Trust, London, UK.
St George's, University of London, London, UK.
Eur J Orthop Surg Traumatol. 2021 Jul;31(5):901-909. doi: 10.1007/s00590-021-02988-0. Epub 2021 May 12.
This review provides a summary of recent evidence surrounding the treatment of paediatric tibial shaft fractures and presents an algorithm to aid management of these injuries. This article reviews the relevant anatomy, epidemiology and aetiology of tibial shaft fractures and summarises contemporary treatment principles. Management recommendations and supporting evidence are given for fractures according to age (< 18 months, 18 months-5 years, 6-12 years, and 13-18 years). The relative merits of casting, plate fixation, elastic and rigid intramedullary nailing, and external fixation are discussed. Special attention is paid to the management of open tibial shaft fractures and to complications including infection and acute compartment syndrome.
There has been a shift away from non-operative management of paediatric tibial shaft fractures over the last 30 years. However, recent evidence highlights that a non-operative approach produces acceptable outcomes when used in simple closed fractures at any age. Operative management may be indicated for unstable fractures where satisfactory alignment cannot be maintained or in specific circumstances including open injuries and polytrauma. Open injuries require urgent assessment by a combined orthopaedic and plastic surgery team at a specialist tertiary centre.
本文综述了近期关于儿童胫骨骨干骨折治疗的证据，并提出了一种算法以帮助这些损伤的管理。本文回顾了胫骨骨干骨折的相关解剖学、流行病学和病因学，并总结了当代治疗原则。根据年龄（<18 个月、18 个月至 5 岁、6-12 岁和 13-18 岁），给出了骨折的管理建议和支持证据。讨论了石膏固定、钢板固定、弹性和刚性髓内钉以及外固定的优缺点。特别关注开放性胫骨骨干骨折的处理以及感染和急性骨筋膜室综合征等并发症。
在过去的 30 年中，儿童胫骨骨干骨折的非手术治疗方法发生了转变。然而，最近的证据表明，在任何年龄段，对于简单的闭合性骨折，非手术方法可产生可接受的结果。对于不稳定骨折，或者无法维持满意对线的情况，或者在特定情况下，包括开放性损伤和多发伤，可能需要手术治疗。开放性损伤需要由骨科和整形外科联合团队在专门的三级中心进行紧急评估。
