CHOC Children's Hospital, Orange, CA.
Rady Children's Hospital - San Diego, San Diego, CA.
J Pediatr Orthop. 2024 Aug 1;44(7):e588-e591. doi: 10.1097/BPO.0000000000002712. Epub 2024 Jun 13.
Fractures of the distal tibial epiphysis in children are often accompanied by articular surface disruption. With increased displacement, internal fixation is frequently performed with an epiphyseal screw to close the fracture gap. Despite limited, high-level clinical evidence to support implant removal, epiphyseal screws are commonly removed after fracture healing due to potentially increased contact forces on the tibiotalar joint. The purpose of this study was to investigate and compare outcomes and complications in children that underwent surgical treatment of distal tibial epiphyseal fractures with placement of an epiphyseal screw(s) and had the implant(s) retained versus removed at a minimum of 2-year postoperative follow-up.
Children younger than 18 years from two urban tertiary care centers who underwent operative management of distal tibia Salter-Harris III and IV fractures using epiphyseal screws (2013-2020) were divided into two cohorts: retained epiphyseal screws and implant removed. Demographics, intraoperative, postoperative, and radiographic data were collected. Patient-reported outcomes (PROs) using the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numeric Evaluation (SANE) questionnaires were collected at the final follow-up. Statistical analysis, including power analysis, was performed.
Fifty-two children were included (30 males, 22 females) with a mean age of 13.3 years at the time of injury (range, 7.7-16.4 years). Thirty-five children retained the implants; seventeen had implants removed. All completed the FAAM questionnaires at a mean follow-up of 4.4 ± 1.9 years, while 29 completed the SANE questionnaire at a mean follow-up of 4.4 ± 1.7 years. No statistically significant difference in patient demographics, surgical variables, or PROs was observed. Six children experienced complications from the initial surgery, including infections and complex regional pain syndrome, with no difference in complication rates between the cohorts ( P =0.08). Furthermore, no complication was observed as a result of implant removal.
Children with retained epiphyseal implants have similar functional outcomes as compared with those who had implants removed after distal tibial epiphyseal fracture fixation and union.
Level III-Retrospective comparative study.
儿童胫骨远端骺板骨折常伴有关节面破坏。随着移位的增加，通常采用骺板螺钉进行内固定以闭合骨折间隙。尽管有有限的高水平临床证据支持取出内植物，但由于距骨关节上的接触力可能增加，骺板螺钉在骨折愈合后通常会被取出。本研究旨在调查和比较儿童胫骨远端骺板骨折手术治疗中使用骺板螺钉（s）并在至少 2 年的术后随访中保留（s）与取出（s）的结果和并发症。
将 2013 年至 2020 年在两个城市三级护理中心接受手术治疗的胫骨远端 Salter-Harris III 和 IV 型骨折的 18 岁以下儿童分为两组：保留骺板螺钉和取出内植物。收集了人口统计学、术中、术后和影像学资料。在最后一次随访时，使用足踝能力测量（FAAM）和单一评估数字评估（SANE）问卷收集了患者报告的结果（PROs）。进行了统计分析，包括功效分析。
52 例儿童纳入研究（男 30 例，女 22 例），受伤时平均年龄为 13.3 岁（7.7-16.4 岁）。35 例儿童保留了植入物，17 例儿童取出了植入物。所有儿童在平均 4.4±1.9 年的随访时完成了 FAAM 问卷，而 29 例儿童在平均 4.4±1.7 年的随访时完成了 SANE 问卷。两组患者的人口统计学、手术变量或 PROs 均无统计学差异。6 例儿童在初始手术后发生并发症，包括感染和复杂性区域疼痛综合征，两组的并发症发生率无差异（P=0.08）。此外，在去除植入物后，没有观察到并发症。
与胫骨远端骺板骨折固定和愈合后取出骺板内植物的儿童相比，保留骺板内植物的儿童具有相似的功能结果。
III 级-回顾性比较研究。
