Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL.
Division of Orthopaedic Surgery, Children's Hospital of Philadelphia.
J Pediatr Orthop. 2024;44(10):e876-e882. doi: 10.1097/BPO.0000000000002766. Epub 2024 Jul 9.
Given the rare nature of tibial tubercle fractures, previous studies are mostly limited to small, single-center series. This results in practice variation. Previous research has shown poor surgeon agreement on utilization of advanced imaging, but improved evidence-based indications may help balance clinical utility with resource utilization. The purpose of this study is to quantify diagnostic practices for tibial tubercle fractures in a large, multicenter cohort, with attention to the usage and impact of advanced imaging.
This is a retrospective series of pediatric tibial tubercle fractures from 7 centers between 2007 and 2022. Exclusion criteria were age above 18 years, missing demographic and pretreatment data, closed proximal tibial physis and tubercle apophysis, or a proximal tibia fracture not involving the tubercle. Demographic and injury data were collected. Fracture classifications were derived from radiographic evaluation. The utilization of advanced imaging was recorded as well as the presence of findings not identified on radiographs. Standard descriptive statistics were reported, and χ 2 tests were performed (means reported±SD).
A total of 598 patients satisfied the inclusion criteria, of which 88.6% (530/598) were male with a mean age of 13.8±1.9 years. Internal oblique x-rays were obtained in 267 patients (44.6%), computed tomography (CT) in 158 (26.4%), and magnetic resonance imaging (MRI) in 64 (10.7%). There were significant differences in the frequency at which CT (7.2% to 79.4%, P <0.001) and MRI were obtained (1.5% to 54.8%, P <0.001). CT was obtained most frequently for Ogden type IV fractures (50/99, 50.5%), and resulted in novel findings that were not visualized on radiographs in a total of 37/158 patients (23.4%). The most common finding on CT was intra-articular fracture extension (25/37). MRI was obtained most frequently for Ogden type V fractures (13/35, 37.1%), and resulted in novel findings in a total of 31/64 patients (48.4%). The most common finding was patellar tendon injury (11/64), but only 3 of these patients required tendon repair.
Substantial variation exists in the diagnostic evaluation of tibial tubercle fractures. CT was most helpful in clarifying intra-articular involvement, while MRI can identify patellar tendon injury, periosteal sleeve avulsion, or a nondisplaced fracture. This study quantifies variation in diagnostic practices for tibial tubercle fractures, highlighting the need for evidence-based indications for advanced imaging.
Level III.
由于胫骨结节骨折较为罕见，既往研究大多局限于小样本、单中心的系列研究。这导致了实践中的差异。既往研究表明，外科医生在使用高级影像学检查方面的意见不一致，但改善基于证据的适应证可能有助于平衡临床实用性与资源利用。本研究的目的是在一个大型多中心队列中量化胫骨结节骨折的诊断实践，重点关注高级影像学的使用和影响。
这是一项回顾性研究，纳入了 2007 年至 2022 年间 7 个中心的小儿胫骨结节骨折患者。排除标准为年龄大于 18 岁、术前数据缺失、胫骨近端骺板和结节骺闭合、或胫骨近端骨折不累及结节。收集患者的人口统计学和损伤数据。骨折分类来源于影像学评估。记录高级影像学的使用情况以及在 X 线片上未发现的发现。报告标准描述性统计数据，并进行 χ 2 检验（报告均值±标准差）。
共有 598 例患者符合纳入标准，其中 88.6%（530/598）为男性，平均年龄为 13.8±1.9 岁。267 例患者（44.6%）行胫骨内斜位 X 线片检查，158 例患者（26.4%）行 CT 检查，64 例患者（10.7%）行 MRI 检查。CT（7.2%至 79.4%，P<0.001）和 MRI（1.5%至 54.8%，P<0.001）的使用率存在显著差异。CT 检查最常用于 Ogden Ⅳ型骨折（50/99，50.5%），共 37/158 例（23.4%）患者的 CT 检查发现了 X 线片上未显示的新发现。CT 最常见的发现是关节内骨折延伸（25/37）。MRI 检查最常用于 Ogden Ⅴ型骨折（13/35，37.1%），共 31/64 例（48.4%）患者的 MRI 检查发现了新发现。最常见的发现是髌腱损伤（11/64），但只有 3 例患者需要进行腱修复。
胫骨结节骨折的诊断评估存在很大差异。CT 检查最有助于明确关节内受累情况，而 MRI 检查可识别髌腱损伤、骨膜袖套撕脱或无移位骨折。本研究量化了胫骨结节骨折诊断实践中的差异，突出了高级影像学检查基于证据的适应证的必要性。
III 级。
