Clinical observation of cannulated screw fixation for distal tibial epiphysis fracture in adolescents

Abstract

Objective To explore the clinical curative effect of hollow screw internal fixation for the treatment of distal epiphyseal teenagers tibial fracture. Methods Thirty-nine cases of epiphyseal fractures of the distal tibia were treated in Shanghai Children′s Hospital between February 2005 and September 2014.This study included 24 boys and 15 girls with the average age of 13.1 years (ranged 10.5 to 16.2 years old). Preoperative diagnosis was confirmed by the X-ray films or CT examination.All the cases were closed fractures and manipulative reduction all failed.Surgical reduction was performed when plain radiographs showed the fracture gap of epiphysis board and articular surface were greater than 2 mm or after closed reduction.Under C-arm X-ray machine, ankle axial traction was performed initially.Anatomical reduction underwent according to the bone fracture type.The fractures were fixed with cannulated screws by percutaneous or open approach.Postoperative X-ray or CT confirmed anatomical reduction at articular surface and growth plate.All patients had been immobilized with short-leg cast for 4-6 weeks.The ankle joint function and growth were evaluated by means of American Orthopaedic Foot and Ankle Society(AOFAS) Ankle Hindfoot Scale. Results All patients were followed up for 5 to 91 months with an average duration of 35 months.X-ray films showed that all fractures were bone healing.No uneven articular surface was found and there was no extremity rotation and shorte-ning deformity.Results were evaluated by AOFAS scoring system: excellent in 27 cases, good in 10 cases, and general in 2 cases.All patients were able to participate in the normal physical activities. Conclusions CT with multiplanar reconstruction is a premise to make an accurate diagnosis and to choose a reasonable approach.For failed closed reduction for adolescent distal tibial epiphyseal fractures, the cannulated screws are simple and may have a satisfactory effect. Key words: Tibial Fractures; Epiphyses; Adolescent