Jaswinder Singh, Hitesh Shah, K Venkatadass, Janki Sharan Bhadani, John Mukhopadhaya
{"title":"晚期出现股骨远端关节内骨折的手术治疗结果：多中心回顾性病例系列。","authors":"Jaswinder Singh, Hitesh Shah, K Venkatadass, Janki Sharan Bhadani, John Mukhopadhaya","doi":"10.1007/s43465-024-01324-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Distal femur physeal fractures in children, particularly Hoffa fractures, are rare and prone to complications. This study aims to evaluate the outcomes of surgical intervention in children presenting with delayed intraarticular distal femur physeal fractures.</p><p><strong>Materials and methods: </strong>A multicentric retrospective study involving six pediatric patients with delayed presentation of distal femur physeal fractures was conducted. Five patients underwent surgical intervention involving osteotomy and anatomical refixation of the malunited fragments. One patient opted for conservative management. The age at presentation, time since injury, surgical procedures, and clinical and radiological outcomes were evaluated at the final follow-up. Fixation with lag screws was sufficient in three patients, while two required additional plate stabilization.</p><p><strong>Results: </strong>The mean age of patients was 12.2 years, comprising four boys and two girls. The average delay in presentation was 30.8 months (ranging from 3 months to 8 years). For the surgical group (<i>n</i> = 5), the knee range of motion improved from an average of 16-66 degrees preoperatively to 6-128 degrees postoperatively at a mean follow-up of 60 months. The mean limb shortening was 3 cm (range 0.5-5 cm). Two patients required additional procedures for distal femur varus malalignment. The conservatively managed patient showed no improvement in knee movements at the 12 month follow-up, serving as a control.</p><p><strong>Conclusions: </strong>Surgical intervention involving osteotomy and anatomical reduction for malunited intraarticular Salter-Harris type III and IV fractures of the distal femur in children yields good to excellent outcomes. Limb length discrepancy and malalignment, if present, can be addressed separately. Longer follow-up until skeletal maturity is necessary to evaluate final outcomes in these patients.</p><p><strong>Level of evidence: </strong>Level IV (Case series). Therapeutic.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-024-01324-y.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"426-437"},"PeriodicalIF":1.1000,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973006/pdf/","citationCount":"0","resultStr":"{\"title\":\"Outcomes of Surgical Management of Late Presenting Intra-Articular Distal Femoral Physeal Fracture: A Multicentric Retrospective Case Series.\",\"authors\":\"Jaswinder Singh, Hitesh Shah, K Venkatadass, Janki Sharan Bhadani, John Mukhopadhaya\",\"doi\":\"10.1007/s43465-024-01324-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Distal femur physeal fractures in children, particularly Hoffa fractures, are rare and prone to complications. This study aims to evaluate the outcomes of surgical intervention in children presenting with delayed intraarticular distal femur physeal fractures.</p><p><strong>Materials and methods: </strong>A multicentric retrospective study involving six pediatric patients with delayed presentation of distal femur physeal fractures was conducted. Five patients underwent surgical intervention involving osteotomy and anatomical refixation of the malunited fragments. One patient opted for conservative management. The age at presentation, time since injury, surgical procedures, and clinical and radiological outcomes were evaluated at the final follow-up. Fixation with lag screws was sufficient in three patients, while two required additional plate stabilization.</p><p><strong>Results: </strong>The mean age of patients was 12.2 years, comprising four boys and two girls. The average delay in presentation was 30.8 months (ranging from 3 months to 8 years). For the surgical group (<i>n</i> = 5), the knee range of motion improved from an average of 16-66 degrees preoperatively to 6-128 degrees postoperatively at a mean follow-up of 60 months. The mean limb shortening was 3 cm (range 0.5-5 cm). Two patients required additional procedures for distal femur varus malalignment. The conservatively managed patient showed no improvement in knee movements at the 12 month follow-up, serving as a control.</p><p><strong>Conclusions: </strong>Surgical intervention involving osteotomy and anatomical reduction for malunited intraarticular Salter-Harris type III and IV fractures of the distal femur in children yields good to excellent outcomes. Limb length discrepancy and malalignment, if present, can be addressed separately. Longer follow-up until skeletal maturity is necessary to evaluate final outcomes in these patients.</p><p><strong>Level of evidence: </strong>Level IV (Case series). 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Outcomes of Surgical Management of Late Presenting Intra-Articular Distal Femoral Physeal Fracture: A Multicentric Retrospective Case Series.
Introduction: Distal femur physeal fractures in children, particularly Hoffa fractures, are rare and prone to complications. This study aims to evaluate the outcomes of surgical intervention in children presenting with delayed intraarticular distal femur physeal fractures.
Materials and methods: A multicentric retrospective study involving six pediatric patients with delayed presentation of distal femur physeal fractures was conducted. Five patients underwent surgical intervention involving osteotomy and anatomical refixation of the malunited fragments. One patient opted for conservative management. The age at presentation, time since injury, surgical procedures, and clinical and radiological outcomes were evaluated at the final follow-up. Fixation with lag screws was sufficient in three patients, while two required additional plate stabilization.
Results: The mean age of patients was 12.2 years, comprising four boys and two girls. The average delay in presentation was 30.8 months (ranging from 3 months to 8 years). For the surgical group (n = 5), the knee range of motion improved from an average of 16-66 degrees preoperatively to 6-128 degrees postoperatively at a mean follow-up of 60 months. The mean limb shortening was 3 cm (range 0.5-5 cm). Two patients required additional procedures for distal femur varus malalignment. The conservatively managed patient showed no improvement in knee movements at the 12 month follow-up, serving as a control.
Conclusions: Surgical intervention involving osteotomy and anatomical reduction for malunited intraarticular Salter-Harris type III and IV fractures of the distal femur in children yields good to excellent outcomes. Limb length discrepancy and malalignment, if present, can be addressed separately. Longer follow-up until skeletal maturity is necessary to evaluate final outcomes in these patients.
Level of evidence: Level IV (Case series). Therapeutic.
Supplementary information: The online version contains supplementary material available at 10.1007/s43465-024-01324-y.
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IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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