Cerclage percutané des fractures du tibia chez l'enfant. A propos de 34 cas

Abstract

The results obtained by circumferential wiring of 34 fractures of the tibial shaft in children treated between 1958 and 1987 are reviewed. Of the patients treated, 22 were males and 12 were females. Their mean age was 13 (7 to 16) years. 26 fractures involved both the tibia and fibula, 8 were isolated tibial fractures; 26 fractures were closed and 6 were compound; 28 fractures were due to torsion, 6 were the result of bending. 22 patients required surgery for secondary displacement or inadequate reduction by traction, 6 for compound fractures. “Loose wiring” for minimizing periosteal damage was not found to be useful. Patients were immobilized in long-leg plaster casts for 11 weeks postoperatively; wires were removed after a mean interval of 12 weeks. Complications were absent throughout; infections and malunion were not seen. 14 patients were available for clinical and radiographic follow-up. Results of 12 patients with comparable torsion fractures and fracture management are reviewed: In these persistent lateral displacement was irrelevant; malalignment was negligible and did not require corrective surgery. The mathematical mean of leg shortening and lengthening was of greatest significance: It was found to be −1.3 (+8 AE −14) mm post-operatively and −2.5 (+8 AE −20) mm at the follow-up visit. If indicated, cerclage of tibial shaft fractures in children, which can be done percutaneously in most cases, is a safe procedure with few complications and excellent results. While complementary to conservative fracture management, it is not an alternative to it.