Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method (original) (raw)
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Physeal injuries of the distal tibia: long-term results in 376 patients
International Orthopaedics, 2010
The aim of this study was to evaluate our treatment of distal tibial physeal injuries retrospectively and explain the relationship between the trauma mechanism, the radiographic injury pattern, the subsequent therapy and the functional outcome, as well as to further deduce and verify prognostic criteria. At the Department of Trauma Surgery, Vienna Medical University, 419 children and adolescent patients with physeal injuries of the distal tibia were treated from 1993 to 2007, of these 376 were included in our study and evaluated retrospectively. Seventy-seven displaced physeal fractures of the distal tibia were reconstructed anatomically by open or closed reduction and produced 95% excellent results. A perfect anatomical reduction, if necessary by open means, should be achieved to prevent a bone bridge with subsequent epiphysiodesis and post-traumatic deformities due to growth inhibition and/or retardation.
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2017
Distal tibia physeal fractures can lead to growth complications such as premature physeal closure (PPC), angular deformity and leg length discrepancy. The aim of our study was to systematically review the literature to assess whether open reduction and internal fixation (ORIF) is associated with lower rates of PPC compared to closed treatment. We searched several databases from 1966 to 2016 for studies that evaluated ORIF versus closed treatment of distal tibia physeal fractures. We performed a meta-analysis using a random effects model to pool odds ratios (OR) for the comparison of PPC rate between children undergoing ORIF versus closed treatment. We also investigated the PPC rate in Salter-Harris (S-H) type I and II fractures. Descriptive, quantitative and qualitative data were extracted. Out of the 253 articles identified, six retrospective cohort studies were eligible, with a total of 970 distal tibia physeal fractures. The pooled OR of PPC between ORIF and closed treatment show...
International Journal of Orthopaedics Sciences, 2021
Introduction: Tibia shaft fractures are very common in children usually they are following fall. Generally they are very well treated with conservative management, but surgical intervention becomes mandatory in the presence of unstable, comminuted fractures with poor skin condition and compartment syndromes . Material and Methods: There were 6 compound comminuted tibia fractures in between age group of 5 – 15 years. All were treated with ilizarov ring fixator application in department of orthopaedics of Pravara institute of medical science (DU) from April 2019 to January 2021. Results: Early mobilization was initiated in all patients as per pain tolerance by post-operative day 2 or 3. Fracture united in all cases, no residual deformity seen in any case. Mild pintract infection was seen in 3 cases which were treated with regular dressings & oral antibiotics. No delayed union, re fracture, limb length discrepancy was seen in any case, no bone grafting, corrective osteotomy was require...
Archives of trauma research, 2013
Tibial fractures are the third most common pediatric long-bone fracture after forearm and femoral fractures. Approximately 50% of pediatric tibial fractures occur in the distal third of the tibia. This is followed by midshaft tibial fractures (39%), and least commonly, the proximal third of the tibia is involved. Tibial fractures in the skeletally immature patient can usually be treated without surgery but tibial fractures resulting from high energy traumas are of special importance considering type of the selected treatment method affecting the children future. Manipulation and casting are regarded as definite treatments for children tibial fractures. They are used following compartment syndrome in poly-trauma, neurovascular damages, open fractures, and fasciotomy cases. In children, most open fractures occur due to high energy traumas and inappropriate treatment of the fractures may result in several complications. Flexible intramedullary nailing is one of the popular options as a...
Lower limb deformity following proximal tibia physeal injury: long-term follow-up
Journal of Orthopaedics and Traumatology Official Journal of the Italian Society of Orthopaedics and Traumatology, 2012
Background Proximal tibial physeal injuries are quite rare, but their complications can be of great importance. The purpose of this study was to evaluate the effect of this injury on the axis and length of a child's limb. Materials and methods This study focused on 12 patients with proximal physeal injury of the tibia (8 boys and 4 girls; mean age at the time of injury: 8.9 years). Injuries were classified according to the Salter-Harris scheme into 5 types (type II-7 patients, type III-3 patients, type IV-1 patient, type V-1 patient). In 5 cases, a coexisting fracture of the injured limb was observed (fibular fracture-3 cases, intercondylar fracture-1 case, tibial tubercle fracture-1 case). Ten patients were treated conservatively and 2 patients underwent an operation. Seven of the 12 patients were available for long-term follow-up, with a mean duration of 14.4 years (11.2-22.0 years). Results Angular deformity was observed in 6 of the 7 patients, with a mean valgus deformity of 2.7°, within an average of 5.8 months after the injury. After 3 years of follow-up, complete remodeling was observed in all of those 6 cases (4 of the patients were treated conservatively and 2 underwent surgery). One patient developed 6 mm of tibial shortening. No functional limitation or pain was recorded in any of the patients during the follow-up. Conclusions Injury to the proximal tibial epiphysis, while rare, may result in angular or length disturbance, regardless of the initial treatment (conservative or surgical). Parents should always be informed of this possibility, and long follow-up is indicated. Nevertheless, this type of injury rarely results in functional limitations.
Journal of Children's Orthopaedics, 2014
Background The use of circular fixators for the treatment of tibial fractures is well established in the literature. The aim of this study was to compare the Ilizarov circular fixator (ICF) with the Taylor spatial frame (TSF) in terms of treatment results in consecutive patients with tibial fractures that required operative management. Method A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, time duration in frame, healing time and complications of treatment. The minimum follow-up was 24 months. Results Ten patients were treated with ICF between 2000 and 2005, while 15 patients have been treated with TSF since 2005. Two of the 10 treated with ICF and 5 of the 15 treated with TSF were open fractures. All patients went on to achieve complete union. Mean duration in the frame was 12.7 weeks for ICF and 14.8 weeks for the TSF group. Two patients in the TSF group had delayed uni...
Open Fractures of the Tibia in Children
Clinical Orthopaedics and Related Research, 1996
Ninety open fractures of the tibia treated at the authors' institution between 1985 and 1994 were retrospectively reviewed. There were 38 Grade I, 35 Grade 11, and 17 Grade I11 fractures. All patients had debridement and lavage of the wound under general anesthesia. Seventeen wounds (19.8%) were closed primarily and 69 (80.2%) were left open. Forty fractures (45.0%) were stabilized in casts, 31 (34.8%) in an external fixator, and 18 (20.2%) with casts and internal fixation. Six patients (7.1 %) had superficial infection occur, 2 had vascular injuries, 1 of whom required an amputation, and only 1 had a neurologic injury. The average time to union was 4.5 months (range, 1.2-28.3 months). There were 10 delayed and 7 nonunions. Multiple regression analysis showed that only age of the patient and grade of the fracture were significantly associated with union time. Open fractures of the tibia in children older than 12 years of age have a high risk of developing delayed or nonunion when compared with the same injuries in children younger than 6 years of age. Closed fractures of the tibia in children are reported to heal rapidly with few complications. 14 Unfortunately, the thin soft tissue envelope covering the tibial shaft makes this bone particularly susceptible to open frac-From the
Oblique Compression Screw Fixation across the Physis for Tillaux Fractures in Adolescent
Objective: Tillaux fractures are uncommon physeal injuries sustained by adolescents. Two different fixation techniques are described; the first involves placement of a screw obliquely into the tibial metaphysis, while the second involves placement of a screw parallel through the epiphysis without violating the physis. The purpose of this study was to report the outcomes, complications, and advantages of oblique screw fixation.