Brown Corey, Kelly Brian A, Brouillet Kirsten, Luhmann Scott J
Meharry Medical College, School of Medicine, Nashville, TN, United States.
Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO, United States.
J Child Orthop. 2021 Dec 1;15(6):515-524. doi: 10.1302/1863-2548.15.210117.
Determine the frequency of compartment syndrome of the leg after displaced, operatively treated modified Ogden I to III tibial tubercle fractures (TTFxs), evaluate the preoperative assessment and use of advanced imaging, and need for prophylactic fasciotomies.
Retrospective analysis of operatively treated, displaced modified Ogden I to III TTFxs, at our level 1 paediatric trauma centre between 2007 and 2019. Modified Ogden Type IV and V fracture patterns were excluded. Fracture patterns were determined by plain radiographs.
There were 49 modified Ogden I to III TTFxs in 48 patients. None had signs nor symptoms of vascular compromise, compartment syndromes or impending compartment syndromes preoperatively. In all, 13 of the 49 fractures underwent anterior compartment fasciotomy at surgery; eight of the 13 had traumatic fascial disruptions, which were extended surgically. All incisions were primarily closed. There were no instances of postoperative compartment syndromes, growth arrest, leg-length discrepancy or recurvatum deformity postoperatively. All patients achieved radiographic union and achieved full range of movement.
The potentially devastating complications of compartment syndrome or vascular compromise following TTFx did not occur in this consecutive series of patients over 12 years. The presence of an intact posterior proximal tibial physis and posterior metaphyseal cortex (Modified Ogden TTFx Type I to III) may mitigate the occurrence of vascular injury and compartment syndrome. Plain radiographs appear appropriate as the primary method of imaging TTFxs, with use of advanced imaging as the clinical scenario dictates. Routine, prophylactic fasciotomies do not appear necessary in Ogden I to III TTFxs, but should be performed for signs and symptoms of compartment syndrome.
Level IV.
确定移位的、经手术治疗的改良奥格登I至III型胫骨结节骨折（TTFxs）后小腿骨筋膜室综合征的发生率，评估术前评估及高级影像学检查的应用情况，以及预防性筋膜切开术的必要性。
对2007年至2019年期间在我们的一级儿童创伤中心接受手术治疗的移位改良奥格登I至III型TTFxs进行回顾性分析。排除改良奥格登IV型和V型骨折模式。骨折模式通过X线平片确定。
48例患者中有49处改良奥格登I至III型TTFxs。术前均无血管损伤、骨筋膜室综合征或即将发生骨筋膜室综合征的体征和症状。49处骨折中有13处在手术时进行了前侧骨筋膜室切开术；13例中有8例存在创伤性筋膜破裂，手术时进行了扩大处理。所有切口均一期缝合。术后无骨筋膜室综合征、生长停滞、下肢长度差异或膝反屈畸形的情况发生。所有患者均实现了影像学愈合，且关节活动范围恢复正常。
在这一系列连续12年的患者中，未发生TTFx后可能导致严重后果的骨筋膜室综合征或血管损伤并发症。完整的胫骨近端后侧骨骺和后侧干骺端皮质（改良奥格登TTFx I至III型）的存在可能会降低血管损伤和骨筋膜室综合征的发生率。X线平片似乎适合作为TTFxs的主要影像学检查方法，可根据临床情况使用高级影像学检查。对于奥格登I至III型TTFxs，常规预防性筋膜切开术似乎没有必要，但出现骨筋膜室综合征的体征和症状时应进行手术。
IV级。
