Application of arthroscopic poking reduction and internal fixation in the treatment of Salter-Harris types Ⅲ and Ⅳ epiphyseal injuries of the distal tibia
Yang Long, Shi Rongjian, Zhou Ji, Sun Jie, Cao Guangchao
Department of Foot and Ankle Surgery, Xuzhou Renci Hospital, Xuzhou 221000, China
Abstract：Objective This study aimed to investigate the effect of arthroscopic poking reduction internal fixation in the treatment of distal tibial Salter-Harris types Ⅲ and Ⅳ epiphyseal injuries. Methods This was a case series report that included the clinical data of 9 foot patients with distal tibial Salter-Harris types Ⅲ and Ⅳ epiphyseal injuries treated with arthroscopic fracture reduction with Kirschner wire or screw fixation at Xuzhou Renci Hospital from June 2020 to June 2022. Among them, 6 cases were male and 3 cases were female (aged 8-15[12.1±2.0] years old). The right foot was in 3 cases and the left foot in 6 cases. Regular postoperative follow-up was performed. The postoperative surgical complications and fracture healing time of the patients were recorded. Ankle function was assessed using the visual analog scoring (VAS) score, and the American Association of Foot and Ankle Surgery (AOFAS) ankle-hindfoot score. Full-length lower extremity films were reviewed every 6 months to measure the force line and length of the affected extremity. The lower limb force line and tibia length were measured to observe the sequelae of epiphyseal injury, and the total length of the tibia was compared between the affected side and the contralateral side at the last follow-up. Results All 9 patients were followed up 6-21(14.7±4.6) months. Postoperatively, all patients achieved one-stage healing of the incision without complications, such as infection and wound dehiscence. Furthermore, the fracture ends all healed well, with the bone healing time was 10-14 (11.9±1.4) weeks. At the final follow-up, the VAS score of the patients was 1 (1, 2), which was significantly improved compared with 6 (5,6) before surgery; this difference was statistically significant (Z=4.50, P=0.004). The AOFAS score was 87-93 (90.0±1.9), and the ankle joint function was excellent. There were no abnormalities in the strength lines of lower limbs in 9 patients, with the length of affected and healthy limbs being 29.2 (28.1, 30.4) cm and 29.4 (28.3, 30.5) cm, respectively, with no statistical significance (Z=-2.50, P=0.063). None of the patients had any deformities, such as shortening or inversion of the affected limb. Conclusion The treatment of distal tibial Salter-Harris types Ⅲ and Ⅳ epiphyseal injuries with ankle arthroscopic poking reduction internal fixation is less traumatic. The patients recover quickly, the epiphysis heal well, and the short-term follow-up is satisfactory. The results indicate that this procedure is a reliable solution for the minimally invasive treatment of distal tibial Salter-Harris types Ⅲ and Ⅳ epiphyseal injuries.
杨龙, 石荣剑, 周吉, 孙杰, 曹广超. 关节镜下撬拨复位内固定在胫骨远端Salter-Harris Ⅲ、Ⅳ型骨骺损伤治疗中的应用[J]. 中华解剖与临床杂志, 2023, 28(7): 448-453.
Yang Long, Shi Rongjian, Zhou Ji, Sun Jie, Cao Guangchao. Application of arthroscopic poking reduction and internal fixation in the treatment of Salter-Harris types Ⅲ and Ⅳ epiphyseal injuries of the distal tibia. Chinese Journal of Anatomy and Clinics, 2023, 28(7): 448-453.
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2023, Vol. 28 
