Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2024 Apr 1;44(4):e316-e322. doi: 10.1097/BPO.0000000000002610. Epub 2024 Jan 5.
The standard of care for tibial shaft fractures in young children is nonoperative management, while in adults, operative treatment is considered the mainstay. There are no clear guidelines on preferred treatment for adolescents.
This paper aims to 1) identify clinical and radiographic characteristics predictive of malalignment and 2) determine if treatment type affects malalignment risk.
This retrospective cohort study identified patients aged 12 to 16 years old with a tibial shaft fracture at a Level 1 pediatric trauma center. The primary outcome of interest was malalignment, classified as meeting one or more of the following: >5° coronal angulation, >5° sagittal angulation, translation (cortical width or 100% displaced), and/or rotational deformity. Comparative analyses were done to identify risk factors for malalignment.
A total of 162 patients were included-initial treatment was "planned nonoperative" for 102 patients and "planned operative" for 60 patients. The malalignment rate was 34% in the planned nonoperative group versus 32% in the planned operative group. In a multivariate regression, older patients [odds ratio (OR)=-0.07, 95% CI: -0.13 to -0.01; P =0.024] and those with 100% initial displacement (OR=-0.35, 95% CI: -0.64 to -0.05; P =0.021) had decreased odds of malalignment, and having increased sagittal angulation (OR=0.02, 95% CI: 0.01-0.04; P =0.002) and a fibula fracture (OR=0.22, 95% CI: 0.03-0.41; P =0.023) increased the odds of malalignment. There was no difference in the rate of malalignment by initial treatment ( P =0.289). Having a planned nonoperative treatment (OR=22.7, 95% CI: 14.0-31.5; P <0.001) and having a fibula fracture (OR=8.52, 95% CI: 0.59-16.45; P =0.035) increased the time immobilized.
This study provides insight into factors affecting tibial shaft fracture alignment among patients aged 12 to 16 years. This study suggests that the risk of malalignment is higher among patients with increased initial sagittal angulation and concomitant fibula fractures, but the risk of malalignment is comparable in patients initially treated nonoperatively and operatively. Although healing parameters on average were similar, nonoperative treatment results in longer immobilization time and time for unrestricted weight bearing.
Level III-retrospective comparative study.
儿童胫骨骨干骨折的标准治疗方法是非手术治疗，而在成人中，手术治疗被认为是主要治疗方法。对于青少年，没有明确的首选治疗指南。
本文旨在 1）确定预测对线不良的临床和影像学特征，2）确定治疗类型是否影响对线不良的风险。
这项回顾性队列研究纳入了在一家 1 级儿科创伤中心就诊的年龄在 12 至 16 岁之间的胫骨骨干骨折患者。主要研究结果是对线不良，定义为符合以下一种或多种情况：冠状面成角 >5°，矢状面成角 >5°，平移（皮质宽度或 100%移位）和/或旋转畸形。进行了比较分析以确定对线不良的危险因素。
共纳入 162 例患者-102 例初始治疗为“计划非手术”，60 例为“计划手术”。计划非手术组的对线不良率为 34%，计划手术组为 32%。多变量回归分析显示，年龄较大的患者（比值比[OR]=-0.07，95%置信区间：-0.13 至-0.01；P=0.024）和初始完全移位的患者（OR=-0.35，95%置信区间：-0.64 至-0.05；P=0.021）发生对线不良的可能性较低，而矢状面成角增加（OR=0.02，95%置信区间：0.01-0.04；P=0.002）和腓骨骨折（OR=0.22，95%置信区间：0.03-0.41；P=0.023）会增加对线不良的可能性。初始治疗方式对线不良率无差异（P=0.289）。计划非手术治疗（OR=22.7，95%置信区间：14.0-31.5；P<0.001）和腓骨骨折（OR=8.52，95%置信区间：0.59-16.45；P=0.035）会增加固定时间。
本研究提供了 12 至 16 岁患者胫骨骨干骨折对线影响因素的相关信息。本研究表明，初始矢状面成角增加和同时合并腓骨骨折的患者对线不良风险较高，但初始非手术和手术治疗的患者对线不良风险相似。虽然平均愈合参数相似，但非手术治疗会导致更长的固定时间和无限制负重的时间。
III 级-回顾性比较研究。
