Analysis of Clinical Outcomes in Pediatric Distal Tibia Triplanar Fractures Treated Surgically and Conservatively

Abstract

Purpose We aimed to analyze the clinical and functional outcomes of patients who underwent surgery or received conservative treatment to look into the impact of treatment methods on clinical outcomes. Methods A retrospective study was performed on 25 patients with a minimum one-year follow-up. Patients were divided into two groups based on joint and physis displacement measured on preop CT images. Patients with a displacement of > 2 mm underwent surgery, while those with a displacement of < 2 mm received conservative treatment. The clinical results were assessed using the Ankle-Hindfoot Scale developed by the American Orthopedic Foot and Ankle Society (AOFAS) and the Modified Weber Protocol (MWP). Results The sample consisted of 14 patients who underwent surgery and 11 patients who received conservative treatment. The surgical group had a mean follow-up of 36.79±14.43 months, while the conservative group had a mean follow-up of 31.82±13.55 months. The surgical and conservative groups had a postop 1st-year AOFAS score of 96.64±3.54 and 93.64 ± 4.69, respectively. The difference was statistically insignificant (p > 0.05), but the surgical group had higher scores numerically. The surgical and conservative groups had a postop 6th-month AOFAS score of 84.64±1.64 and 80.82±2.85, respectively. The difference was statistically significant (p < 0.05). Conclusion The results of both surgical treatment and conservative treatment are satisfactory. Especially, surgical treatment should not be avoided in patients requiring surgery with a displacement of more than 2 mm and surgeons may consider surgery for better clinical outcomes and earlier rehabilitation in the treatment of triplane fractures.

Fracturas controvertidas de miembro inferior en niños y adolescentes: un debate basado en la evidencia

“…Aunque en términos globales son lesiones poco frecuentes (entre 3 a 7% del total de fracturas de tobillo en la edad pediátrica), constituyen una de las lesiones fisarias más significativas en la adolescencia, hasta 15%. 107 El tratamiento conservador es de elección en aquellas fracturas con un desplazamiento inferior a 2-2.5mm, 108,109 si bien existe controversia sobre cuál es la mejor técnica quirúrgica para aquellas fracturas con un desplazamiento superior. Un metaanálisis 104 del año 2020 pone de manifiesto que el tratamiento clásico más utilizado es la RAFI, 105,110 pero la literatura más actualizada aboga por un cambio de tendencia a favor a la reducción cerrada y síntesis percutánea (RCSP).…”

Comparison of Open Reduction and Internal Fixation With Minimally Invasive Plating in the Treatment of Distal Tibial Fractures: A Retrospective Study

“…The fracture line may extend to the ankle joint with the ankle joint being indirectly affected. This is a region in which false union (with shortness, angulation, and rotation) is less tolerated, and conservative treatment is therefore rarely preferred recently [ 2 ].…”