Residual angulation of distal tibial diaphyseal fractures in children younger than ten years
- PDF / 1,956,758 Bytes
- 7 Pages / 595.276 x 793.701 pts Page_size
- 11 Downloads / 168 Views
RESEARCH ARTICLE
Open Access
Residual angulation of distal tibial diaphyseal fractures in children younger than ten years Sung Taek Jung1, Hyuk Park2, Ju-Hyung Lee3 and Jung Ryul Kim2*
Abstract Background: The purpose of this study was to evaluate the factors that influence residual angulation after treating pediatric distal tibial diaphyseal fractures. Methods: We retrospectively reviewed the records of 75 children under the age of ten who were treated at two referral centers for distal tibial diaphyseal fractures. The mean patient age was 6.8 ± 2.3 years, and the mean follow-up duration was 4.1 ± 1.3 years (range, 3 to 6 years). Early postoperative and late follow-up radiographs were used to measure angulation. Results: Twenty-four patients had valgus angulations >5° at the final follow-up. There was no varus, or anteroposterior residual angulations >5°. There was more residual valgus angulation when the postoperative angulation was >5° (p = 0.006) and when intramedullary nail and external fixators were applied for treatment (p = 0.004). Multivariate logistic regression analysis showed that postoperative angulation (adjusted odds ratio (OR) 4.33, 95% confidence interval (CI) 1.07–17.53) and treatment methods (intramedullary nail: adjusted OR 7.33, 95% CI 1.31–41.07; external fixator: adjusted OR 11.35, 95% CI 1.91–67.40 compared with the cast group) were associated with residual deformity. Conclusions: Valgus angulation after pediatric distal tibial fractures persisted in this study sample. Accurate reduction should be performed to prevent residual deformity. Keywords: Residual deformity, Distal tibia, Diaphysis, Remodeling
Background The normal process of bone remodeling in the diaphysis and metaphysis of a growing child may realign initially malunited fragments. This dynamic remodeling makes the anatomic reduction less significant in a child than it is in a comparable injury in an adult. Children’s bones remodel in response to the normal stresses of body weight, muscle action, joint reaction forces, and intrinsic control mechanisms including the periosteum [1-3]. If there is any residual angulation after bone union, there is spontaneous correction. The physis responds to such malalignment by differential growth, which aligns the shaft perpendicular to the major joint reaction forces [4]. In general, axial malalignments will remodel in children after forearm or femoral shaft fractures. However, tibial angular deformities, especially distal tibial fractures, are less favorable injuries with regard to remodeling. The * Correspondence: [email protected] 2 Department of Orthopaedics Surgery, Chonbuk National University Medical School, 567 Baekje-ro, Dukjin-gu, Jeonju 561-756, South Korea Full list of author information is available at the end of the article
remodeling process in such injuries is complicated because of the activity of the muscles in the anterior and lateral compartments of the lower leg and the decreased growth potential of the distal tibia compared to that of the proximal tibia [4-6]. Cozen inv
Data Loading...
