Abstract：
BACKGROUND: Fractures of the distal tibial epiphysis in children are often accompanied by articular surface disruption. With increased displacement, internal fixation is frequently performed with an epiphyseal screw to close the fracture gap. Despite limited, high-level clinical evidence to support implant removal, epiphyseal screws are commonly removed after fracture healing due to potentially increased contact forces on the tibiotalar joint. The purpose of this study was to investigate and compare outcomes and complications in children that underwent surgical treatment of distal tibial epiphyseal fractures with placement of an epiphyseal screw(s) and had the implant(s) retained versus removed at a minimum of 2-year postoperative follow-up.
METHODS: Children younger than 18 years from two urban tertiary care centers who underwent operative management of distal tibia Salter-Harris III and IV fractures using epiphyseal screws (2013-2020) were divided into two cohorts: retained epiphyseal screws and implant removed. Demographics, intraoperative, postoperative, and radiographic data were collected. Patient-reported outcomes (PROs) using the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numeric Evaluation (SANE) questionnaires were collected at the final follow-up. Statistical analysis, including power analysis, was performed.
RESULTS: Fifty-two children were included (30 males, 22 females) with a mean age of 13.3 years at the time of injury (range, 7.7-16.4 years). Thirty-five children retained the implants; seventeen had implants removed. All completed the FAAM questionnaires at a mean follow-up of 4.4 ± 1.9 years, while 29 completed the SANE questionnaire at a mean follow-up of 4.4 ± 1.7 years. No statistically significant difference in patient demographics, surgical variables, or PROs was observed. Six children experienced complications from the initial surgery, including infections and complex regional pain syndrome, with no difference in complication rates between the cohorts ( P =0.08). Furthermore, no complication was observed as a result of implant removal.
CONCLUSIONS: Children with retained epiphyseal implants have similar functional outcomes as compared with those who had implants removed after distal tibial epiphyseal fracture fixation and union.
METHODS: Level III-Retrospective comparative study.
METHODS: Children younger than 18 years from two urban tertiary care centers who underwent operative management of distal tibia Salter-Harris III and IV fractures using epiphyseal screws (2013-2020) were divided into two cohorts: retained epiphyseal screws and implant removed. Demographics, intraoperative, postoperative, and radiographic data were collected. Patient-reported outcomes (PROs) using the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numeric Evaluation (SANE) questionnaires were collected at the final follow-up. Statistical analysis, including power analysis, was performed.
RESULTS: Fifty-two children were included (30 males, 22 females) with a mean age of 13.3 years at the time of injury (range, 7.7-16.4 years). Thirty-five children retained the implants; seventeen had implants removed. All completed the FAAM questionnaires at a mean follow-up of 4.4 ± 1.9 years, while 29 completed the SANE questionnaire at a mean follow-up of 4.4 ± 1.7 years. No statistically significant difference in patient demographics, surgical variables, or PROs was observed. Six children experienced complications from the initial surgery, including infections and complex regional pain syndrome, with no difference in complication rates between the cohorts ( P =0.08). Furthermore, no complication was observed as a result of implant removal.
CONCLUSIONS: Children with retained epiphyseal implants have similar functional outcomes as compared with those who had implants removed after distal tibial epiphyseal fracture fixation and union.
METHODS: Level III-Retrospective comparative study.
摘要：
背景：儿童胫骨远端骨phy骨折常伴有关节面破坏。随着流离失所的增加，内固定通常使用骨phy螺钉进行，以闭合骨折间隙。尽管有限，高水平的临床证据支持植入物移除，骨phy螺钉通常在骨折愈合后被移除，因为胫骨关节上的接触力可能会增加。这项研究的目的是调查和比较儿童的结果和并发症，这些儿童接受了胫骨远端骨phy骨折的手术治疗，并放置了骨phy螺钉，并且在至少2年的术后随访中保留了植入物。
方法：来自两个城市三级护理中心的18岁以下儿童接受了胫骨远端Salter-HarrisIII和IV骨折的手术治疗（2013-2020年）。人口统计,术中,术后,并收集射线照相数据。在最后的随访中收集使用足踝能力测量（FAAM）和单一评估数字评估（SANE）问卷的患者报告结果（PRO）。统计分析,包括功率分析，已执行。
结果：包括52名儿童（30名男性，22名女性），受伤时平均年龄为13.3岁（范围，7.7-16.4年）。35名儿童保留了植入物；17名儿童移除了植入物。所有人都完成了FAAM问卷，平均随访时间为4.4±1.9年，29人完成了SANE问卷，平均随访4.4±1.7年。患者人口统计学无统计学差异，手术变量，或观察到PROs。六个孩子从最初的手术中经历了并发症，包括感染和复杂的区域疼痛综合征，两组间并发症发生率无差异（P=0.08）。此外，未观察到植入物移除导致的并发症.
结论：与胫骨远端骨phy骨折固定和愈合后取出植入物的儿童相比，保留骨phy植入物的儿童具有相似的功能结局。
方法：III级回顾性比较研究。
方法：来自两个城市三级护理中心的18岁以下儿童接受了胫骨远端Salter-HarrisIII和IV骨折的手术治疗（2013-2020年）。人口统计,术中,术后,并收集射线照相数据。在最后的随访中收集使用足踝能力测量（FAAM）和单一评估数字评估（SANE）问卷的患者报告结果（PRO）。统计分析,包括功率分析，已执行。
结果：包括52名儿童（30名男性，22名女性），受伤时平均年龄为13.3岁（范围，7.7-16.4年）。35名儿童保留了植入物；17名儿童移除了植入物。所有人都完成了FAAM问卷，平均随访时间为4.4±1.9年，29人完成了SANE问卷，平均随访4.4±1.7年。患者人口统计学无统计学差异，手术变量，或观察到PROs。六个孩子从最初的手术中经历了并发症，包括感染和复杂的区域疼痛综合征，两组间并发症发生率无差异（P=0.08）。此外，未观察到植入物移除导致的并发症.
结论：与胫骨远端骨phy骨折固定和愈合后取出植入物的儿童相比，保留骨phy植入物的儿童具有相似的功能结局。
方法：III级回顾性比较研究。
