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Topic:

Lateral Humeral Condyle Fracture

Issue:

Elbow

Category:

Trauma

Title:

Not Just Small Adults: Operative Versus Nonoperative Treatment in Adolescent Tibial Shaft Fractures

Author:

Kiani, Sara N. MD, MPH; Badrinath, Raghav MD; Baldwin, Keith D. MD, MPH, MSPT

Journal:

Journal of Pediatric Orthopaedics

Date:

April 2024

Reference:

44(4):p e316-e322, DOI: 10.1097/BPO.0000000000002610

Level Of Evidence:

III

# of Patients:

162

Study Type:

Retrospective comparative study

Location:

A Level 1 pediatric trauma center

Summary:

The study examined the outcomes of operative versus nonoperative treatment in adolescent tibial shaft fractures, focusing on malalignment risks and healing parameters.

Methods:

Patients with tibial shaft fractures were retrospectively reviewed and categorized into “planned nonoperative” (102 patients) and “planned operative” (60 patients) treatment groups. Malalignment was defined by specific radiographic criteria: >5° coronal or sagittal angulation, cortical translation, and/or rotational deformity. Statistical analyses identified predictors of malalignment and compared outcomes across groups.

Exclusions:

Patients outside the 12–16 age range, incomplete radiographic data, or non-tibial shaft fractures.

Results:

Malalignment occurred in 34% of the nonoperative group and 32% of the operative group (P=0.289). Risk factors for malalignment included increased sagittal angulation (P=0.002) and concomitant fibula fractures (P=0.023). Planned nonoperative treatment led to longer immobilization and restricted weight-bearing durations compared to operative treatment (P<0.001).

Conclusions:

Both nonoperative and operative treatments have comparable malalignment risks. Patients with high initial sagittal angulation or fibula fractures should be carefully monitored for malalignment. Nonoperative treatment involves longer recovery periods, particularly regarding immobilization and weight-bearing restrictions.

Relevance:

Limitations:

Perspective:

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