Jessica L Koshinski, Joshua T Bram, Preston W Gross, Sarah H Hine, Daniel S Hayes, Peter D Fabricant, Mark A Seeley
{"title":"探讨青少年患者胫骨刚性髓内钉治疗的效果。","authors":"Jessica L Koshinski, Joshua T Bram, Preston W Gross, Sarah H Hine, Daniel S Hayes, Peter D Fabricant, Mark A Seeley","doi":"10.1097/BOT.0000000000002957","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on postoperative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center.</p><p><strong>Patient selection criteria: </strong>Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen 42 A to C fractures between March 2009 and January 2024 with postoperative follow-up more than 1-year.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was change in tibial slope after RIMN. Secondary outcomes included postoperative weight-bearing status and complications.</p><p><strong>Results: </strong>Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month postoperative radiographs (mean 18.4 ± 12.7 months), there was no significant change from preoperative to postoperative tibial slope (80.0 ± 1.9 vs. 80.1 ± 1.6 degrees, P = 0.86). Time to achievement of full weight-bearing across the series averaged 45.4 ± 35.6 days. Five patients (14%) underwent hardware removal, and 89% of patients reported that they had returned to \"normal\" activity at the latest follow-up (mean 56.2 ± 42.5 months).</p><p><strong>Conclusions: </strong>This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated postoperative complications indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"186-191"},"PeriodicalIF":1.6000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients.\",\"authors\":\"Jessica L Koshinski, Joshua T Bram, Preston W Gross, Sarah H Hine, Daniel S Hayes, Peter D Fabricant, Mark A Seeley\",\"doi\":\"10.1097/BOT.0000000000002957\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on postoperative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center.</p><p><strong>Patient selection criteria: </strong>Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen 42 A to C fractures between March 2009 and January 2024 with postoperative follow-up more than 1-year.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was change in tibial slope after RIMN. Secondary outcomes included postoperative weight-bearing status and complications.</p><p><strong>Results: </strong>Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month postoperative radiographs (mean 18.4 ± 12.7 months), there was no significant change from preoperative to postoperative tibial slope (80.0 ± 1.9 vs. 80.1 ± 1.6 degrees, P = 0.86). Time to achievement of full weight-bearing across the series averaged 45.4 ± 35.6 days. Five patients (14%) underwent hardware removal, and 89% of patients reported that they had returned to \\\"normal\\\" activity at the latest follow-up (mean 56.2 ± 42.5 months).</p><p><strong>Conclusions: </strong>This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated postoperative complications indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. 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Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients.
Objectives: To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on postoperative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.
Methods:
Design: Retrospective case series.
Setting: A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center.
Patient selection criteria: Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen 42 A to C fractures between March 2009 and January 2024 with postoperative follow-up more than 1-year.
Outcome measures and comparisons: The primary outcome was change in tibial slope after RIMN. Secondary outcomes included postoperative weight-bearing status and complications.
Results: Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month postoperative radiographs (mean 18.4 ± 12.7 months), there was no significant change from preoperative to postoperative tibial slope (80.0 ± 1.9 vs. 80.1 ± 1.6 degrees, P = 0.86). Time to achievement of full weight-bearing across the series averaged 45.4 ± 35.6 days. Five patients (14%) underwent hardware removal, and 89% of patients reported that they had returned to "normal" activity at the latest follow-up (mean 56.2 ± 42.5 months).
Conclusions: This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated postoperative complications indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining.
Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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