Ibezim Chizitam, Price Stephanie, Souder Christopher, Kaufman Brian, Ellington Matthew
University of Texas at Austin, Dell Medical School, Austin, TX, USA.
J Pediatr Soc North Am. 2024 Feb 28;6:100023. doi: 10.1016/j.jposna.2024.100023. eCollection 2024 Feb.
Postoperative immobilization of tibial tubercle fractures (TTF) has historically been in the form of a long leg cast (LLC). The purpose of this study was to determine the functional outcome differences between LLC and hinged knee brace (HKB) in the postoperative management of TTF.
We retrospectively reviewed TTF that underwent open reduction and internal fixation from May 2010 to February 2022 at a single Level 1 pediatric trauma center. Data parameters retrieved from the electronic medical record included: age, gender, body mass index, mechanism of injury, immobilization length of time, Immobilization type (HKB or LLC), time to full weight-bearing, time to return to play/sport, and time to full range of motion (ROM). Imaging was also reviewed to document Ogden classification, postoperative residual displacement, and time to radiographic fracture union. Differences in complications and management between the cohorts were evaluated.
A total of 64 patients ( = 65 TTF) were included for final analysis. Fifty fractures (76.9%) received a HKB while 15 (23.1%) were treated in an LLC. The mean age was 13.9 (±1.0) years, the gender composition was 92% male, and the mean body mass index was 25.6 (±5.7). There was no difference in the demographic data between cohorts. The median follow-up was 7 months (Interquartile Range 5-11 months). The main mechanism of injury was basketball (38.5%) and more than half of the TTF were Ogden type III (55.4%). The complication rate of the HKB cohort was 14% compared to 40% for the LLC cohort ( = .03). The HKB cohort returned to full ROM nearly 1 full month ahead of LLC patients (93 days vs 122 days, = .02). There was no difference between the 2 groups with regard to time to full weight-bearing or return to play. There was also no difference in postoperative displacement or time to fracture union. Reduction with residual displacement greater than 4 millimeters was associated with delayed healing (104 days vs 60 days, < .001).
Patients who sustain TTF can be effectively rehabilitated postoperatively in an HKB. HKB displayed expedited ROM recovery and was associated with a lower complication rate.
(1)Tibial tubercle fractures patients can be effectively rehabilitated postoperatively in an Hinged knee brace.(2)Those treated with Hinged knee brace vs Long leg cast displayed expedited ROM recovery.(3)Those treated with Hinged knee brace vs Long leg cast were associated with a lower complication rate.
III.
胫骨结节骨折（TTF）术后固定传统上采用长腿石膏（LLC）的形式。本研究的目的是确定LLC和铰链式膝关节支具（HKB）在TTF术后管理中的功能结局差异。
我们回顾性分析了2010年5月至2022年2月在一家一级儿童创伤中心接受切开复位内固定术的TTF患者。从电子病历中检索的数据参数包括：年龄、性别、体重指数、损伤机制、固定时间、固定类型（HKB或LLC）、完全负重时间、恢复运动/体育活动时间以及恢复全关节活动范围（ROM）的时间。还对影像学资料进行了回顾，以记录奥格登分类、术后残余移位以及影像学骨折愈合时间。评估了两组之间并发症和治疗的差异。
共有64例患者（共65处TTF）纳入最终分析。50处骨折（76.9%）使用了HKB，15处（23.1%）采用LLC治疗。平均年龄为13.9（±1.0）岁，性别构成中男性占92%，平均体重指数为（±5.7）。两组之间的人口统计学数据无差异。中位随访时间为7个月（四分位间距5 - 11个月）。主要损伤机制为篮球运动（38.5%），超过一半的TTF为奥格登III型（55.4%）。HKB组的并发症发生率为14%，而LLC组为40%（P = 0.03）。HKB组比LLC组患者提前近1个月恢复全关节活动范围（93天对122天，P = 0.02）。两组在完全负重时间或恢复运动方面无差异。术后移位或骨折愈合时间也无差异。残余移位大于4毫米的复位与愈合延迟相关（104天对60天，P < 0.001）。
TTF患者术后使用HKB可有效康复。HKB显示出更快的关节活动范围恢复，且并发症发生率较低。
（1）胫骨结节骨折患者术后使用铰链式膝关节支具可有效康复。（2）与长腿石膏相比，使用铰链式膝关节支具治疗的患者关节活动范围恢复更快。（3）与长腿石膏相比，使用铰链式膝关节支具治疗的患者并发症发生率较低。
III级
