The midterm outcomes of ankle Dias-Tachdjian pronation-eversion external rotation physeal fracture in children treated by open reduction internal fixation with one-stage medial-lateral combined incision

Abstract

The objective of this study was to report the midterm outcomes and complications of ankle Dias-Tachdjian pronation-eversion external rotation (PEER) physeal fracture in children treated by ORIF with combined medial and lateral incision. A total of 21 children with ankle Dias-Tachdjian PEER physeal fracture underwent open reduction internal fixation treatment with combined medial and lateral incision between January 2015 and October 2017. The lateral distal tibia angle (LDTA) was measured to evaluate angular deformity and the X-rays were taken to evaluate the premature physeal arrest. All patients were followed up for an average time of 20.1 months (ranging from 17 to 25 months). Bone healing was achieved in all cases. American Orthopedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) score of the patients improved from median 31 (11, 38) preoperation to median 68 (63, 73) postoperation to median score 91 (87, 96) at last follow-up. LDTA of the patients improved from 70.5 ± 4.9 preoperation to 90.0 ± 1.2 postoperation, to measure 90.6 ± 3.7 at last follow-up. The differences were statistically significant ( P < 0.05). There is no premature physeal closure, ankle deformity in 19 cases. They could normally exercise and take part in normal sport activities. The remaining two cases had physeal bone bridge and premature physeal closure but could still carry on daily activities and thus were categorized as good. ORIF with one-stage medial-lateral combined incision for ankle Dias-Tachdjian PEER physeal fracture can decrease the rate of premature physeal closure and should be a treatment choice.

A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures

“…30 There are few studies evaluating functional scores after DTPFs. 6,30 In a recent case series, investigators only included pronation-eversion-external rotation injuries treated with ORIF and reported significant improvements in functional outcomes. 6 In another study investigating triplane fractures, investigators reported excellent functional outcomes in both conservative and operative groups.…”

“…6,30 In a recent case series, investigators only included pronation-eversion-external rotation injuries treated with ORIF and reported significant improvements in functional outcomes. 6 In another study investigating triplane fractures, investigators reported excellent functional outcomes in both conservative and operative groups. 30 We observed 96.3 ± 4.8 AOFAS score in the CR-PF group and 94.8 ± 5.9 in patients who underwent ORIF.…”

“…There are few studies evaluating functional scores after DTPFs 6,30 . In a recent case series, investigators only included pronation-eversion-external rotation injuries treated with ORIF and reported significant improvements in functional outcomes 6 .…”

“…These fractures have an unpredictable prognosis with respect to PPC 5 . Moreover, the definition of acceptable or suitable reduction is still debatable in displaced SH-II DTPF 6 . Therefore, more clinical follow-up evidence is needed to clearly understand the prognosis of these fractures 5 …”

Compliance of functional exercises in school-age children with limb fractures: implication for nursing countermeasures

“…The results of this study show that school-age children’s compliance with functional exercises after limb fractures is low, which suggests that compliance with functional exercises after school-age children’s limb fractures is affected by multiple factors. Individualized interventions can effectively improve the compliance of school-age children with limb fractures [ 30 ]. Functional exercise compliance helps children recover as soon as possible.…”