Rehabilitation of simultaneous bilateral epiphysial fracture of proximal tibia in adolescent

Early-Stage Physical Therapy for a Patient With Proximal Tibial Fracture With Acute Compartment Syndrome and Neurovascular Deficits Managed With External Fixation Complicated by Chronic Osteomyelitis: A Case Report

Tibial fractures occur following low-energy and high-energy trauma resulting from indirect and direct impacts, respectively. High-velocity trauma like road traffic accidents usually results in open fractures of the tibia associated with acute compartment syndrome, posing a serious threat. Thus, this injury requires prompt operative management with fasciotomy followed by fixating the fracture with an external fixator to avoid infection. Despite all the efforts, sometimes this condition may lead to osteomyelitis of the tibia requiring further care. Meanwhile, the patient has to be kept immobilized for a longer duration of time, which allows further complications to occur. Therefore, structured physiotherapeutic management of patients postoperatively is of immense necessity to prevent complications associated with prolonged immobility and achieve an optimal level of functional independence, thereby facilitating the patient to come back to near-normal life as soon as possible. Our case report provides a structured early-stage postoperative physical therapy treatment protocol for a patient with a proximal tibial fracture with acute compartment syndrome and neurovascular deficit managed with Ilizarov fixation.

Pediatric Trauma

Musculoskeletal injuries of the lower limb are frequent in pediatric patients and represent the most common cause of emergency department admissions. Acute sports-related injuries commonly involve the lower extremity, as the knee and ankle are the most frequently injured parts. Physeal fractures are common injuries in children and adolescents participating in contact sports, which may lead to growth disturbances and cause limb length discrepancy. It is imperative for pediatric trauma centers to implement evidence-based multispecialty protocols for the perimanagement of the injured child, especially through the postdischarge and rehabilitation phases, in order for the child to resume active daily living.

Salter-Harris Type 2 Injury of the Proximal Tibial Epiphysis in a 15-year-old Athlete: A Rare Case Report

Background

Proximal tibial epiphyseal injuries in adolescents are uncommon accounting to 0.5 to 3 % of all epiphyseal injuries. Although rare, the proximity of popliteal artery puts this region at an increased risk of vascular injury and compartment syndrome. Also, premature closure of the growth plate can cause restrictions in growth and angular malformations. The fractures may often be missed on routine X-rays. Frequent monitoring and further testing should be done to better diagnose these injuries.

Case History

We present a case of an adolescent football player (15 years old) who injured his left knee and was diagnosed to have Salter- Harris II proximal tibial epiphyseal injury. Routine radiographs revealed minimal widening in his epiphysis anteriorly when compared to his contralateral knee. Magnetic resonance imaging (MRI) findings revealed a fracture passing through the growth plate of proximal tibia exiting posteriorly into the tibial metaphysis. Management included closed manipulation and plaster cast immobilization with regular follow-ups. At the end of 1.5 years, the patient had full range of motion without any residual deformities.

Conclusions

High clinical suspicion is required to diagnose these rare injuries. When in doubt, MRI is advocated to better delineate the fracture as the potential complications can be limb threatening. Anatomical reduction and adequate immobilization should be done to prevent deformities and good functional outcome in the long term.

A correlation analysis of short-term imaging manifestations and long-term function using ROC curve after tibial fracture surgery

OBJECTIVE

To investigate the correlation between short-term imaging techniques and long-term function using receiver operating characteristic (ROC) curve after tibia fracture surgery.

METHODS

Seventy patients with tibia fracture admitted to our hospital were selected as the study subjects, and were divided into a < 60 years old group (n = 40) and a ≥ 60 years old group (n = 30), a removed internal fixation group (n = 26) and a retained internal fixation group (n = 44). The short-term imaging results, long-term function, the degree of pain, the range of ankle joint motion, and the subjective satisfaction of patient care were scored and compared among the four groups. The influencing factors of subjective satisfaction of patients were analyzed using logistic regression analysis.

RESULTS

There were marked differences in the scores of Jakim, Garland & Werley scoring system, and Kofoed's scale and subjective satisfaction between the < 60 years old group and the ≥ 60 years old group, and between the removed internal fixation group and the retained internal fixation group (P < 0.05), but there was no remarkable difference in visual analog scale (VAS) scores (P > 0.05). Spearman's correlation analysis revealed a correlation between the short-term imaging manifestations and the long-term function in tibia fracture patients, and the correlation was remarkable in patients aged < 60 years without internal fixation (P < 0.05). Logistic correlation analysis showed that Kofoed's scale scores were significantly correlated with patients' subjective satisfaction (P < 0.05).

CONCLUSION

There is a correlation between early imaging and long-term function in tibia fracture patients, and the correlation was remarkable in patients aged < 60 years and without internal fixation. The range of joint motion and degree of pain are the primary influencing factors for evaluation of patients' subjective satisfaction.