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Gonzalez-Morgado D, Vargas Meouchi EA, Soza Leiva D, Carbonell Rosell C, Sevil Mayayo R, Pacha-Vicente D. Acromial physeal fracture in an adolescent: a case report and literature review. JSES Int 2024; 8:6-10. [PMID: 38312296 PMCID: PMC10837692 DOI: 10.1016/j.jseint.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Diego Gonzalez-Morgado
- Orthopaedic Surgery Department, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Enrique Alberto Vargas Meouchi
- Orthopaedic Surgery Department, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Diego Soza Leiva
- Orthopaedic Surgery Department, Pediatric Orthopedics Unit, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carla Carbonell Rosell
- Orthopaedic Surgery Department, Pediatric Orthopedics Unit, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Raquel Sevil Mayayo
- Orthopaedic Surgery Department, Pediatric Orthopedics Unit, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Daniel Pacha-Vicente
- Orthopaedic Surgery Department, Pediatric Orthopedics Unit, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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Kurniawan A, Amin BF, Canintika AF. Surgical outcome of distal tibia Salter Harris II fracture in osteopetrosis patient. Int J Surg Case Rep 2023; 113:109090. [PMID: 38007865 PMCID: PMC10746852 DOI: 10.1016/j.ijscr.2023.109090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION Osteopetrosis is a rare genetic disorder characterized by increased bone density. This condition is clinically manifested with a brittle intramedullary structure and reduced bone toughness, increasing the risk of fracture. A limited case has been reported on the management of physeal fracture in patients with osteopetrosis. The objective of this study is to report a rare osteopetrosis patient who sustains Salter-Harris II at the distal tibia with its long-term follow-up along with its literature review. PRESENTATION OF CASE We report a case of a four-year-old boy with an established a diagnosis of osteopetrosis brought by the parents to the emergency department after sustaining a fall while playing in the playground. Radiological examination revealed a Salter-Harris type II distal tibial fracture. The patient underwent closed reduction and fixation using the cannulated screw. 18-month postoperative patients have an uneventful healing. DISCUSSION Osteopetrosis is caused by impaired osteoclast function and differentiation, leading to impaired in remodelling. Salter-Harris type II distal tibial fracture can be treated by either closed reduction or open reduction. A closed reduction was performed successfully with cannulated screw in his patient. CONCLUSION There is a delayed union of fracture in osteopetrosis patient. This will increase the risk of displacement which will eventually resulted in growth disturbance. Delayed weight bearing and stable fixation is highly recommended.
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Affiliation(s)
- Aryadi Kurniawan
- Department of Orthopaedics & Traumatology, Ciptomangunkusumo General Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Salemba Jakarta Pusat, Jakarta 10430, Indonesia.
| | - Bany Faris Amin
- Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Salemba Jakarta Pusat, Jakarta 10430, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics & Traumatology, Ciptomangunkusumo General Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Salemba Jakarta Pusat, Jakarta 10430, Indonesia
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Kim WG, Laor T, Jarrett DY. Physeal injuries of the clavicle: pediatric counterparts to adult acromioclavicular and sternoclavicular joint separations. Pediatr Radiol 2023; 53:1513-1525. [PMID: 36935435 DOI: 10.1007/s00247-023-05617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 03/21/2023]
Abstract
The epiphyses at the medial and lateral ends of the clavicle are small, ossify relatively late, and may not fuse until early adulthood. Because of this unique anatomy, pediatric and young adult injuries that involve the clavicle often differ from the patterns typically seen in older adults. Clavicular trauma that affects the acromioclavicular joint laterally or sternoclavicular joint medially often results in a physeal fracture and as such, can go unrecognized or be mistaken for a joint dislocation. Radiographic assessment is challenging, particularly when the epiphysis is not yet ossified. However, MR imaging allows for visualization of the cartilage, periosteum and perichondrium, and ligaments of the affected joints. Lateral clavicle physeal injuries can be categorized by the Dameron and Rockwood system, the pediatric correlate to the Rockwood classification of adult acromioclavicular joint injuries. Medial clavicle physeal fractures, similar to adult sternoclavicular joint dislocations, may result in anterior or posterior displacement. Because of their great ability to heal and remodel, clavicular physeal fractures respond better to conservative management than true acromioclavicular or sternoclavicular joint dislocations. Therefore, it is essential to recognize the true nature of these injuries, as there are implications for successful treatment and appropriate prognosis.
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Affiliation(s)
- Wendy G Kim
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tal Laor
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Delma Y Jarrett
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 E. 68Th St., New York, NY, 10065, USA.
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Breen LJ, Coleridge MOD, O'Brien T. The Surgical Repair of a Salter-Harris Type-2 Physeal Fracture of the Proximal Phalanx in a Foal. J Equine Vet Sci 2023; 126:104500. [PMID: 37105415 DOI: 10.1016/j.jevs.2023.104500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
A 6-month-old thoroughbred colt foal was referred to a private equine referral hospital for evaluation of an acute onset, left hind limb lameness. On arrival the foal was 4/5 lame on the left hind at walk and there was diffuse swelling of the left hind pastern and fetlock region. The physical exam was otherwise unremarkable. Digital radiographs of the left hind pastern identified a Salter-Harris type-2 physeal fracture of the proximal phalanx. The fracture was initially treated conservatively using a cast, but the immobilization was not sufficient at achieving adequate reduction. As a result, the fracture was stabilized surgically using a construct consisting of a cortical lag screw, four locking head screws and a locking T-plate. The foal recovered uneventfully and was sound and in race training at a 2 year follow up. This case report highlights that surgical repair via internal fixation is preferable to conservative management of proximal physeal fractures of the first phalanx.
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Affiliation(s)
- Louise J Breen
- Fethard Equine Hospital, O'Bryne & Halley, Fethard, Co. Tipperary, Ireland.
| | | | - Tom O'Brien
- Fethard Equine Hospital, O'Bryne & Halley, Fethard, Co. Tipperary, Ireland
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Oktay A, Kurt Oktay KN, Bulut G, Bekler HI. Combining Salter-Harris and Dias-Tachdjian could be better at determining the prognosis of distal tibial physeal fractures. Injury 2022; 53:1005-1012. [PMID: 35033354 DOI: 10.1016/j.injury.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study is determining the factors that affect prognosis of distal tibial physeal fractures (DTPF) and analyzing whether Salter-Harris (SH) or Dias-Tachdjian (DT) classification is more predictive for outcomes. METHODS Patients treated for DTPF were retrospectively analyzed. Fracture patterns were classified according to SH and DT. Treatment methods and fracture characteristics were noted. Distal tibial angles and joint irregularities were analyzed on patient's final ankle radiographs followed by American Orthopedic Foot and Ankle Score questionnaire. RESULTS 75 patients followed-up between 6 and 96 months meeting the inclusion criteria were evaluated. Joint irregularity was observed in 41.3% and partial premature physeal closure (PPC) in 34.7% of the patients. Lateral distal tibial angle (LDTA) and talocrural angle related deformity were detected in 20% and 14.7% of the patients, respectively. Partial PPC and joint irregularities that have been developed in pronation-eversion-external rotation and supination-inversion injuries (SH type 3, 4) were 62% and 50%, and 42% and 75%, respectively. On follow-ups of supination-external rotation injuries (SH type 2) joint irregularity has never been observed. Following supination-external rotation and supination-plantar flexion injuries, a low rate of partial PPC have been developed; LDTA related deformity was revealed at a high rate of 39.1% after supination-inversion injuries. There weren't any differences observed between the initial displacement, residual displacement or surgical technique and PPC, joint irregularity and angular deformities. Patients treated by ORIF technique had lower AOFAS scores than patients treated by other surgical techniques. CONCLUSIONS In this study it was revealed that SH classification system is not sufficient alone to determine the prognosis of DTPF, the injury mechanisms causing SH types might be also significant in prediction of the prognosis of DTPF.
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Affiliation(s)
- Alper Oktay
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Orthopedics and Trauma Surgery, Turkey.
| | | | - Guven Bulut
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Orthopedics and Trauma Surgery, Turkey
| | - Halil Ibrahim Bekler
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Orthopedics and Trauma Surgery, Turkey
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Jung HS, Park MS, Lee KM, Choi KJ, Choi WY, Sung KH. Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents. Injury 2021; 52:844-848. [PMID: 33526260 DOI: 10.1016/j.injury.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND . This study performed to investigate the incidence of growth arrest such as leg length discrepancy (LLD) and ankle joint angular deformity and its risk factors after physeal fracture of the distal tibia in children and adolescents. MATERIALS AND METHODS . Consecutive 78 patients (mean age 11.4 ± 2.0 years; mean follow-up period 2.0 ± 1.2 years) treated for the distal tibia physeal fracture were included. All patients underwent preoperative ankle radiographs, three-dimensional computed tomography (CT) scans, and postoperative follow-up teleradiogram. Patients were divided into two groups according to the LLD and the difference of lateral distal tibial angle (LDTA) with the contralateral limb as follows: Group 1 (growth arrest), patients with LLD ≥ 1cm or difference of LDTA ≥ 5°; Group 2 (normal growth), patients with LLD < 1cm and difference of LDTA < 5°. RESULTS . The overall incidence of growth arrest was 12.8% (10 of 78). The mean displacement measured using CT scan was 4.4 ± 3.2 mm (range, 0.8-14.9). Of the total 78 fractures, 65 were treated surgically and 13 fractures were treated conservatively. The initial fracture displacement was significantly different between the two groups (p<0.001). However, there were no statistically significant differences between the two groups with respect to other factors. Initial displacement was the only significant risk factor for growth arrest (p<0.003). The cutoff values of initial displacement between the two groups were 5.2mm. CONCLUSIONS . This study showed that degree of initial displacement was the only significant risk factor for growth arrest after physeal fracture of the distal tibia in children and adolescents. Therefore, physicians should consider the possibility of growth arrest for patients with severely displaced physeal fractures of the distal tibia.
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Affiliation(s)
- Hyon Soo Jung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Kug Jin Choi
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Woo Young Choi
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea.
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Edmonds EW, Doan JD, Farnsworth CL. Periosteal incarceration versus interposition adipose tissue grafting in physeal fractures: pilot study in immature rabbits. J Exp Orthop 2019; 6:46. [PMID: 31788750 PMCID: PMC6885469 DOI: 10.1186/s40634-019-0214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose The purpose of this study is to evaluate bar formation following physeal fracture with incarcerated periosteum or adipose tissue graft using radiographic and histological methods in an immature rabbit model. Methods Ten-week-old rabbits underwent induced proximal tibia physeal fractures with a contralateral sham. Fractures had periosteum (n = 5) or adipose tissue (n = 5) interposed. Radiographs were compared over time by tibial medial-lateral side difference (TMLSD)(mm), femoral-tibial angle and tibia plateau angle, and physeal bars evidence. MicroCT was performed, growth plates reconstructed, and physeal area calculated and normalized to same animal contralateral physes. Physeal disruption and chondrocyte organization were evaluated histologically. Results Radiographic: After 6 weeks, physeal bars formed in both periosteum (4 of 4) and fat groups (3 of 5). The periosteum group showed a significant increase in the TMLSD between immediate post-op and 10 days later (p = 0.028); but, after 6 weeks, TMLSD change was not significantly different between the three groups (p = 0.161). MicroCT: The normalized physeal area of every physis in the fat group was more than 0.9 (0.99 ± 0.06). Only half of the periosteum group was over 0.9 (0.81 ± 0.24). Histology: Physeal disruption was seen by microscopic evaluation in none of the sham group, all 4 in the periosteum group and 4 of 5 in the fat group. Conclusions Fat interposition may prevent, or at least delay, the onset of bars across a fractured physis compared to periosteum, but it is not completely protective.
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Affiliation(s)
- Eric W Edmonds
- Division of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA. .,Department of Orthopaedic Surgery, University of California San Diego, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA.
| | - Joshua D Doan
- Division of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA
| | - Christine L Farnsworth
- Division of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5054, San Diego, CA, 92123, USA
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Watanabe H, Majima T, Takahashi K, Iizawa N, Oshima Y, Takai S. Posterior tibial slope angle is associated with flexion-type Salter-Harris II and Watson-Jones type IV fractures of the proximal tibia. Knee Surg Sports Traumatol Arthrosc 2019; 27:2994-3000. [PMID: 30535547 DOI: 10.1007/s00167-018-5319-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/04/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Flexion-type Salter-Harris (SH) II fractures of the proximal tibia, also described as Watson-Jones (WJ) IV fractures, are rare injuries reported among adolescent athletes who are close to skeletal maturity and remain elusive. Due to this classification disagreement, the various treatments range from nonoperative to operative types, and no previous studies have explained the mechanisms of injury or the source of the fracture forces. This retrospective matched case-control study aimed to identify radiological factors that are associated with the fracture forces and to elucidate the mechanisms of these injuries. METHODS Sixteen flexion-type SH II/WJ IV fractures of the proximal tibia in 12 adolescents (12 males, mean age of 14.6 years) were retrospectively reviewed, and knee alignment on plain radiographs was assessed to compare the radiological outcomes of the operated knees (n = 7), nonoperated knees (n = 9), and uninjured contralateral knees (n = 8). The results were compared to healthy age- and sex-matched control subjects (n = 24 knees). RESULTS With regard to the radiological outcomes, the posterior tibial slope angle (PTSA) was significantly greater in the nonoperated knees (19.0° ± 1.6°), operated knees (16.8° ± 1.3°), and uninjured knees (13.6° ± 1.3°) than in the healthy knees of the matched control subjects (9.6° ± 0.4°). The anatomical tibiofemoral angle was significantly less in the nonoperated knees (0.7° ± 0.6°) than in the healthy knees of the matched control subjects (3.7° ± 0.4°). CONCLUSIONS These findings suggest a relationship between an increased PTSA and flexion-type SH II/WJ IV fractures of the proximal tibia, considering the deteriorating effects of an increased PTSA on knee kinematics. Adolescent active athletes with an increased PTSA and partially closed epiphysis of the proximal tibia are at risk for suffering from flexion-type SH II/WJ IV fractures of the proximal tibia until the closure of the proximal tibial epiphysis. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan. .,Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kenji Takahashi
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Norishige Iizawa
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Abstract
PURPOSE OF REVIEW Summarize classic and recent information regarding the unique subset of ankle fractures in children with open growth plates and share the authors' decision-making and surgical techniques. RECENT FINDINGS Recent research on pediatric ankle fractures has centered on the accurate prediction and prevention of growth arrest following fractures of the distal tibia. Another source of discussion is the necessity and benefit of CT scanning in classification and treatment approach. Pediatric ankle fractures continue to pose clinical challenges for orthopedic surgeons. While open anatomic reduction and internal fixation continue to produce good outcomes for intra-articular fractures, outcomes of physeal injuries are more difficult to predict. More studies are needed to determine which patients may benefit more from surgical treatment of physeal injuries.
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Affiliation(s)
- Z. Deniz Olgun
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - Stephanie Maestre
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
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Moon DK, Park JS, Park YJ, Jeong ST. Simultaneous correction of radius and ulna for secondary ulnar impaction syndrome with radial physeal arrest in adolescent: A case report and review of literatures. Int J Surg Case Rep 2018; 50:144-149. [PMID: 30149320 PMCID: PMC6170786 DOI: 10.1016/j.ijscr.2018.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/01/2022] Open
Abstract
Distal radius physeal fractures are common in pediatric patients. Distal radius physeal fracture can lead to physeal arrest. Forearm bone length discrepancy occurs, it is often asymptomatic. Surgical correction of symptomatic forearm bone discrepancy can provide a satisfactory result.
Introduction Distal radius physeal fractures are common in pediatric patients. Although most of these fractures heal without complication, some result in significant physeal arrest. If significant physeal arrest occurs, the various treatment methods can be applied depending on the severity of deformity and remaining growth of the patient. Presentation of case We present a 16-year old female with distal radial physeal arrest who presented four years after initial injury. Radiologically, forearm bone length discrepancy was 7 mm. But, she had a secondary ulnar impaction syndrome. She underwent open wedge corrective osteotomy of distal radius on volar side and ulnar shortening osteotomy, simultaneously. Early mobilization and rehabilitation were started soon after the surgery. At 18 months postoperatively, the ROM was assessed to be almost identical as the unaffected side and the patient presented with no significant symptoms. Discussion Distal radial fracture is one of the most common fractures in pediatric population. And distal radial physis is often involved in these fracture, which can lead to physeal arrest. However, even if forearm bone length discrepancy occurs, if the difference is within 1 cm, it is often asymptomatic. In this case, the forearm bone length discrepancy was mild, but due to symptom, we performed surgical treatment. Conclusion Distal radial physeal arrest due to distal radial fracture is relatively common in children, and long-term follow-up is needed. Moreover, relatively mild deformity caused by physeal arrest may also cause symptoms, so careful observation is needed.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin Sung Park
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Young Jin Park
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Soon Taek Jeong
- Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Holland TS, Prior CP, Walton RD. Distal tibial triplane fracture with ipsilateral tibial shaft fracture: A case series. Surgeon 2018; 16:333-338. [PMID: 29666001 DOI: 10.1016/j.surge.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND & PURPOSE Distal tibial Triplane fracture with ipsilateral tibial shaft fracture is a rare but important problem. This rarely reported combination of injuries if not recognised may lead to deleterious consequences. METHODS/PATIENTS The local database of all emergency admissions was scrutinised to identify subjects before interrogation of the clinical notes and relevant radiographic imaging. FINDINGS This paper reports a series of five children who were found to have triplane fracture of the distal tibia with concomitant ipsilateral fracture of the tibial shaft. CONCLUSIONS We suggest that a high index of suspicion for concomitant fractures should be maintained in the presence of either triplane fracture of the distal tibia or tibial shaft fractures in the peri-adolescent child. Minimum appropriate imaging should include orthogonal full length plain radiographs of the tibia as well as formal ankle radiographs.
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Oda T, Watanabe K. Bare medial epicondyle physeal fracture of the humerus: A case report. J Clin Orthop Trauma 2017; 8:S45-S47. [PMID: 28878540 PMCID: PMC5574838 DOI: 10.1016/j.jcot.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/25/2022] Open
Abstract
We identified an unusual case of the medial epiondyle physeal fracture, which has been caused by a direct blow, accompanied with complete stripping of soft tissue. Surgery was performed for open reduction and internal fixation of the medial epicondyle and reattachment of the anterior oblique bundle of medial collateral ligament and flexor muscle origin. Six months after the surgery, strength of wrist flexion and forearm pronation, range of motion and valgus stability of the left elbow had recovered. One year after the injury, radiographs showed atrophy and sclerosis of the medial epicondylar apophysis. In this type of injury, revascularization of medial epicondyle fracture is not essential for recovery of elbow function when reattachment of the medial collateral ligament and flexor-pronator muscle origin to the distal medial humerus successfully restores stability of the elbow joint.
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Affiliation(s)
- Takashi Oda
- Corresponding author at: Department of Orthopedic Surgery, Hokkaido Saiseikai Otaru Hospital, Otaru, 047-0008, Japan.
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Ogawa T, Shimizu S. Arthroscopically assisted surgical fixation of a juvenile Tillaux fracture and implant removal: A case report. J Clin Orthop Trauma 2017; 8:S32-S37. [PMID: 28878537 PMCID: PMC5574847 DOI: 10.1016/j.jcot.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/13/2017] [Indexed: 10/19/2022] Open
Abstract
Juvenile Tillaux fractures are Salter-Hallis III fractures of the distal tibial epiphysis that occur only when the tibial epiphyses are closing. Theoretically, arthroscopically assisted reduction and fixation of a juvenile Tillaux fracture can facilitate the accurate reconstruction of the articular surface, using arthroscopic visualization. We treated a girl aged 14 years who had a juvenile Tillaux fracture by using arthroscopically assisted reduction and fixation. In order to obtain articular congruency, the screw was inserted under arthroscopic visualization. Although the screw was placed through the epiphysis, the patient had no symptoms of discomfort and the functional results were excellent. We performed a second operation to remove the implant 9 months later. During this procedure, arthroscopy indicated the healing of the fracture site and an intact articular surface. At the 1.5 year follow-up, the radiograph indicated that the epiphysis was closed normally and that the patient had no symptoms. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 100, or excellent. Although screw insertion into the epiphysis should be avoided, reconstructing the congruency of the joint surface is of higher priority in repairing the epiphysis.
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Affiliation(s)
- Takahisa Ogawa
- Corresponding author at: 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki-ken 300-0028, Japan.
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Abstract
While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently. A thorough understanding of the pertinent developmental anatomy is critical for correlating the clinical findings with the imaging work-up, and for anticipating the most common and the most serious complications of each fracture. Diagnosis is usually made with appropriate plain radiographs with advanced imaging often used for preoperative planning. In general, fracture pattern and degree of displacement determine the need for surgical intervention and the overall outcome. While a variety of fixation techniques or constructs may be used, because of the importance of restoring physeal and articular anatomy for avoidance of growth disturbance and degenerative joint disease, respectively, achieving anatomic, rigid fixation is of greater importance than with many other fracture locations in the growing skeleton.
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Schneidmueller D, Sander AL, Wertenbroek M, Wutzler S, Kraus R, Marzi I, Laurer H. Triplane fractures: do we need cross-sectional imaging? Eur J Trauma Emerg Surg 2013; 40:37-43. [PMID: 26815775 DOI: 10.1007/s00068-013-0338-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Diagnosis of Triplane fractures remains difficult in common practice. Aim of the study was the evaluation of the fracture pattern and the benefit of cross-sectional imaging in classification of Triplane-fractures. MATERIAL AND METHODS A total of 27 pediatric patients treated for ankle fractures were identified from patient charts. Radiographic images of epiphyseal fractures (X-rays and additional cross-sectional imaging) were blinded evaluated by 13 observers to answer a specific questionnaire regarding type or fracture and treatment suggestion. RESULTS There were seven Triplane-I and eight Triplane-II fractures. The other physeal ankle fracture group consisted of four patients with a Twoplane-fracture, five Salter-and-Harris (SH) II, one SH-III, and two SH-IV fracture. Accuracy of classification improved considerably depending on the experience of the observer in pediatric trauma care. Surgeons specialized in pediatric trauma care classified correctly with conventional X-rays in 48.1 % of all cases presented versus 31.5 % appropriate diagnosis by younger fellows. Accuracy in exact specification of Triplane-fractures was comparable lesser in younger fellows (31.1 vs. 22 %). Cross-sectional imaging improved classification of all fractures in both groups (75.6 % specialized vs. 47.3 % non specialized). Whereas availability of cross-sectional imaging improved treatment recommendation in specialized surgeons this benefit was not detectable for the doctors without specialization. Evaluation of fracture pattern showed a relatively stereotypical fracture pattern in Triplane-II fractures, whereas Triplane-I fractures were more variable. CONCLUSION The additional information of cross-sectional imaging seems helpful for any physician in finding the right classification of a pediatric ankle fracture. However, the additive information appears especially viable for experienced surgeons to suggest the appropriate treatment.
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Affiliation(s)
- D Schneidmueller
- Trauma Center Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany.
- Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - A L Sander
- Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany
| | - M Wertenbroek
- Department of Surgery, Diaconessenhuis, Meppel, The Netherlands
| | - S Wutzler
- Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany
| | - R Kraus
- Department of Trauma, Orthopaedic, Spine and Pediatric Trauma Surgery, Asklepios Klinik Lich, Lich, Germany
| | - I Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany
| | - H Laurer
- Department of Trauma, Hand, and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany
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