Martus Jeffrey E
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville, TN.
J Pediatr Orthop. 2021 Jul 1;41(Suppl 1):S33-S38. doi: 10.1097/BPO.0000000000001806.
Tibial shaft fractures are common injuries in the adolescent age group. Potential complications from the injury or treatment include infection, implant migration, neurovascular injury, compartment syndrome, malunion, or nonunion.
Published literature was reviewed to identify studies which describe the management options, complications, and outcome of tibial shaft fractures in adolescents.
Acceptable alignment parameters for tibial shaft fractures have been defined. Operative indications include open fractures and other severe soft tissue injuries, vascular injury, compartment syndrome, ipsilateral femoral fractures, and polytrauma. Relative indications for operative treatment are patient/family preference or morbid obesity. Closed reduction and cast immobilization necessitates radiographic observation for loss of reduction over the first 3 weeks. Cast change/wedging or conversion to operative management may be required in 25% to 40%. Flexible nailing provides relative fracture stability while avoiding the proximal tibial physis, but the fracture will still benefit from postoperative immobilization. Rigid nailing provides greater fracture stability and allows early weight bearing but violates the proximal tibial physis. Plate and screw osteosynthesis provide stable anatomic reduction, but there are concerns with delayed union and wound complications related to the dissection. External fixation is an excellent strategy for tibia fractures associated with complex wounds but also requires observation for loss of reduction.
The majority of adolescent tibia shaft fractures can be successfully managed with closed reduction and cast immobilization. Unstable fractures that have failed cast treatment should be treated operatively. Flexible intramedullary nailing, rigid intramedullary nailing, plate and screw osteosynthesis, and external fixation are acceptable treatment options that may be considered for an individual patient depending upon the clinical scenario.
胫骨干骨折是青少年年龄组常见的损伤。损伤或治疗可能引起的并发症包括感染、植入物移位、神经血管损伤、骨筋膜室综合征、畸形愈合或不愈合。
回顾已发表的文献，以确定描述青少年胫骨干骨折治疗选择、并发症及预后的研究。
已明确胫骨干骨折可接受的对线参数。手术指征包括开放性骨折及其他严重软组织损伤、血管损伤、骨筋膜室综合征、同侧股骨骨折和多发伤。手术治疗的相对指征是患者/家属的偏好或病态肥胖。闭合复位及石膏固定需要在最初3周内进行X线观察以了解复位丢失情况。25%至40%的患者可能需要更换石膏/楔形矫正或改为手术治疗。弹性髓内钉可提供相对的骨折稳定性，同时避免近端胫骨骨骺，但骨折术后仍需固定。刚性髓内钉可提供更大的骨折稳定性并允许早期负重，但会破坏近端胫骨骨骺。钢板螺钉内固定可提供稳定的解剖复位，但存在延迟愈合及与手术剥离相关的伤口并发症问题。外固定是治疗伴有复杂伤口的胫骨骨折的极佳策略，但也需要观察复位丢失情况。
大多数青少年胫骨干骨折可通过闭合复位及石膏固定成功治疗。石膏治疗失败的不稳定骨折应行手术治疗。弹性髓内钉、刚性髓内钉、钢板螺钉内固定及外固定都是可接受的治疗选择，可根据具体临床情况为个体患者考虑。
