Manipulative reduction and percutaneous cannulated screws fixation for triplane fractures of the distal tibia in children / 中华骨科杂志

ABSTRACT

Objective To evaluate the result of manipulative reduction and percutaneous cannulated screws fixation for the triplane fracture of the distal tibia in children. Methods From September 2004 to March 2009, 15 cases of triplane fracture of the distal tibia were treated with manipulative reduction and percutaneous cannulated screws fixation. This study included 9 boys with an average age of 13.2 years (range, 12-14 years) and 6 girls with an average age of 12.4 years (range, 11-14 years). Preoperative diagnoses were confirmed by the X-ray films or CT examination. If plain radiographs showed the fracture gap of epiphysis board and articular surface were greater than 2 mm after closed reduction, the operation was needed. Under "C"-arm X-ray machine, anatomical reduction was achieved by manipulative reduction according to the bone fracture type. The fractures were fixed by percutaneous cannulated screw. Postoperative CT scanning confirmed anatomical reduction. All patients had been immobilized with cast for 8 weeks. The ankle joint function and growth were evaluated by modified Weber protocol. Results All patients were followed up for 15 to 68 months with an average of 26 months. There were excellent in 13 cases, good in 2 cases. X-ray films showed all fractures were healed. There were not bone bridge and uneven articular surface, or rotating and shortening deformity. All patients could participate in the normal physical activities. The 2 cases with good outcome were related to weight-bearing too early. The main problem was that pain occurred in ankle joint with excess activity. Conclusion The method of manipulative reduction and percutaneous cannulated screw fixation is relatively reliable treatment for closed triplane fractures of the distal tibia.