Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.
J Orthop Surg Res. 2023 Oct 10;18(1):765. doi: 10.1186/s13018-023-04253-y.
To investigate the clinical effect of the anteromedial cannulated screw approach in the treatment of Hawkins II/III talus fractures in children.
A retrospective study was conducted on 20 children with talar fractures admitted to Renmin Hospital from September 2018 to February 2022. The fracture healing and functional recovery of the affected limb were strictly followed up after the operation. There were 14 males and 6 females. The average age was 9 years (range 6-12 years). According to the Hawkins classification, there were 12 cases of talar neck fracture type II and 8 cases of type III. All patients were fixed with cannulated compression screws via an anteromedial approach. According to the American Orthopedic Foot and Ankle Society ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale was used to evaluate the degree of postoperative pain.
All 20 children were followed up for 12 months to 30 months, with an average of 15 months. We found that there was no significant difference in the excellent and good rate (76.9%) and necrosis rate (30.8%) between male children and female children (71.4%) and necrosis rate (28.6%) (P > 0.05). The excellent and good rates (92.9%) of children younger than 9 years old at the time of injury were higher than those of children older than 9 years old (33.3%), and the incidence of avascular necrosis of the talus was lower. The differences between the two groups were statistically significant (P < 0.05). The average prognosis score of children who underwent surgery within 5 days after injury was 89.2 ± 6.4, which was significantly higher than that of children who underwent surgery after 5 days (72.9 ± 13.1), and the difference was statistically significant (P < 0.05). There was no significant difference between patients who underwent surgery within 5 days after injury (15.4%) and those who underwent surgery after 5 days (51.7%) (P > 0.05). The excellent and good rates of talar neck fracture type II and talar neck fracture type III were 90.1% and 55.6%, respectively.
The anteromedial approach combined with cannulated compression screws for the treatment of Hawkins II/III talus fractures in children not only has a clear surgical field, but the fracture can also be reduced and fixed under direct vision using this technique. It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. It can be used as a surgical scheme for the treatment of talar fractures in children.
探讨前内侧入路空心加压螺钉治疗儿童 Hawkins II/III 型距骨骨折的临床效果。
回顾性分析 2018 年 9 月至 2022 年 2 月在人民医院收治的 20 例距骨骨折患儿的临床资料。术后严格随访患侧骨折愈合及肢体功能恢复情况。男 14 例，女 6 例；年龄 6~12 岁，平均 9 岁。根据 Hawkins 分型：距骨颈骨折Ⅱ型 12 例，Ⅲ型 8 例。均采用前内侧入路空心加压螺钉固定。采用美国矫形足踝协会踝与后足功能评分系统评价术前、术后患侧踝关节及后足功能，采用视觉模拟评分法（VAS）评价术后疼痛程度。
20 例患儿均获随访，随访时间 12~30 个月，平均 15 个月。发现男、女童优良率（76.9%比 71.4%）及坏死率（30.8%比 28.6%）比较，差异均无统计学意义（P>0.05）；9 岁以下患儿优良率（92.9%）高于 9 岁以上患儿（33.3%），距骨坏死发生率较低，差异均有统计学意义（P<0.05）。伤后 5 d 内行手术治疗患儿的平均预后评分为 89.2±6.4，高于伤后 5 d 内行手术治疗患儿的 72.9±13.1，差异有统计学意义（P<0.05）；伤后 5 d 内行手术治疗患儿（15.4%）与伤后 5 d 内行手术治疗患儿（51.7%）的坏死率比较，差异无统计学意义（P>0.05）。距骨颈骨折Ⅱ型和Ⅲ型的优良率分别为 90.1%、55.6%。
前内侧入路联合空心加压螺钉治疗儿童 Hawkins II/III 型距骨骨折，手术视野清晰，可在直视下复位固定骨折，不影响踝关节稳定性，有利于踝关节功能恢复，可作为儿童距骨骨折的一种手术方案。
