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Ramalingam, Wendy G; Carry, Patrick; Brazell, Christopher; Calkins, Ryan; Linza-Moscati, Sara; Stoneback, Jason; Miller, Nancy Hadley
Journal of pediatric orthopaedics. B, 2022-Mar-01, 2022-03-00, 20220301, Letnik: 31, Številka: 2Journal Article
Because adolescent distal third tibia fractures pose treatment challenges, we aimed to identify factors predictive of failure among common treatment methods: casting without manipulation, closed reduction and casting (CRC) and open treatment. Among displaced fractures, we compared outcomes between CRC versus open treatment. Skeletally immature individuals (10-17 years) with extra-articular distal third tibia fractures at a level 1 trauma center (2011-2017) were retrospectively reviewed. Patient demographics, injury and treatment characteristics and complications were recorded. Radiographs were evaluated for unacceptable alignment (angulation >5°, translation >50%, and shortening >1 cm) and time to union. Of 140 individuals, casting was the most common treatment method (n = 81), followed by CRC under anesthesia/sedation (n = 38), and open treatment (n = 34). For fractures casted without manipulation, increased fracture severity based upon our novel grading system hazard ratio (HR): 10.5, 95% CI, 4.2-27.5, P < 0.0001 was significantly related to treatment failure. Outcomes for a selected group of 47 initially displaced fractures (33 CRC and 14 open treatments) were evaluated. For CRC, 9 (27.3%) healed with malunion and 6 (18.2%) failed initial CRC, resulting in a treatment failure rate of 36.7%. For open treatment, 2 (14.3%) underwent hardware removal, 2 (14.3%) healed with malunion and one developed infection requiring reoperation. No fractures healed with malunion required surgical correction during the study period. The odds of persistent malalignment in CRC was 3.77 95% CI, 0.44-32.60, P = 0.2274 times open treatment. Adolescent minimally displaced distal tibial fractures can undergo successful treatment with casting. However, displaced fractures have a higher chance of short-term failure with CRC. Close monitoring of displaced fractures in the adolescent is essential during conservative management.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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Vir: Osebne bibliografije
in: SICRIS
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