Type 4 Tibial Tuberosity Avulsion Fractures: Surgical Treatment Early Outcomes and a Presentation of the Distal Cortical Fixation.

Autor: Segal, David, Dillenkofer, Michael, Wall, Eric J., Tamai, Junichi
Předmět:
Zdroj: Journal of Clinical Medicine; Oct2024, Vol. 13 Issue 19, p5695, 13p
Abstrakt: Background: The most published surgical technique for fixating Type 4 (Salter–Harris II) tibial tubercle avulsion fractures is uni-cortical in nature, and stability is suboptimal. This study presents a technique modification that is consistent with AO principles, by which the screws are aimed distally to purchase the posterior cortex of the distal fragment. This technique is defined as a "Distal Cortical Fixation". This modification has not been studied to date and harbors potential advantages. We aimed to assess the safety and efficacy of surgical fixation techniques for the above-mentioned fractures and to describe the new modification. Methods: A retrospective review was conducted at a level 1 children's hospital for surgically treated Salter–Harris II tibial tubercle fractures. Inclusion criteria were patients who sustained Salter–Harris II tibial tubercle avulsion fractures and were documented to reach one of two radiographic endpoints: union (regardless of alignment) or non-union that necessitated additional interventions. Medical records and radiographic studies were analyzed for fracture union and alignment. A comparative analysis was conducted to evaluate outcomes based on different fixation techniques that included Distal Cortical Fixation, a Proximal Screw Technique, and a crossed or multiple screws/pins construct. Results: A total of 37 patients were included with a mean age of 14.8 ± 1.2 years, with 34/37 (91.9%) being male. The most common procedure was a 1 to 3 screw fixation with a Distal Cortical Fixation (n = 21 (56.75%)), followed by a Proximal Screw Technique (n = 8, 21.62%), and a crossed or multiple screws/pins construct (n = 8, 21.62%). There was no difference between the groups in medical history and demographic features. The mean follow-up duration was 35.17 ± 36.79 weeks. There were no non-unions, and only a minimal change in the sagittal and coronal alignment (0.4 ± 1.94 (p = 0.872) and 0.53 ± 3.51 (p = 0.296) degrees, respectively) was noted and was not associated with the surgical technique. Conclusions: The surgical treatment of Salter–Harris II tibial tubercle avulsion fractures, including Distal Cortical Fixation, was presented and was found to provide satisfactory union rates on a short term follow up. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje