| Objective: To compare the clinical effects and complications of calcaneal skeleton traction and elastic stable intramedullary nailing internal fixation in the treatment of tibial shaft fractures in children aged 5 years and over,so as to guide clinical practice.Methods: The children with tibial fracture treated in the Department of Orthopaedics in Shenzhen children’s hosptial from 2013 to 2018 were analyzed retrospectively.According to the treatment method,the patients were divided into two groups: elastic stable intramedullary nailing internal fixation group(Elastic Stable intramedullary nail,ESIN group,n = 122)and calcaneal skeleton traction group(Calcaneal skeleton traction,CST group,n = 64).The demographic characteristics,fracture features,imaging data,postoperative complications,hospital stay,fracture healing time,weight-bearing time,treatment score and medical expenses of all children were analyzed and compared in the two groups.The curative effect of postoperative follow-up was evaluated according to the Johner-Wruh standard of tibial fracture healing.Long-term follow-up was performed to observe the cases of Limb length difference(LLD),knee and ankle joint activity,abnormal gait and so on.Results: A total of 186 children were included in the study,and all received radiographic and clinical follow-up to fracture healing and were able to begin weight bearing and full mobility.The follow-up time was 3-6 months,with an average of 4.5months.According to the Johner-Wruh criteria for tibial fracture healing,in the ESIN group,44 cases were excellent,74 cases were good,5 cases were medium,and 1 case was poor.In CST group,22 cases were excellent,34 cases were good,6 cases were fair and 0 cases were poor.The follow-up time ranged from 2 to 6 years with an average of 3.5 years.No LLD,knee-ankle joint movement restriction and gait abnormality were found in the all patients at final long-term follow-up.The patients were followed up for a long time including 109 cases in ESIN group and 54 cases in CST group with an average follow-up time of 3.5 years.Twenty-three children were lost to follow-up.The 163 children with long-term follow-up had no LLD,no limitation of knee and ankle joint movement,and no abnormal gait.Of the 186 children included,121 were males and 65 were females.There were 87 cases of falling injury,96 cases of traffic accident injury,1 case of falling injury,1 case of sports injury and 1 case of crushing injury.The fracture types were divided into transverse type(n = 40),oblique type(n = 104),spiral type(n = 7)and comminuted type(n = 35).There was no significant difference in age and sex between the two groups(P > 0.05).In the 122 children treated with elastic stable intramedullary nailing,all fractures healed,and the mean healing time was(68.5±17.9)d.The change of coronal plane angle after fracture healing was(3.5±5.9)°,and the change of sagittal plane angle after fracture healing was(3.1 ± 3.7)°.The average starting time of movement(functional exercises)of the affected limb was(65.02 ± 2.6)d,and the average weight bearing time of the affected limb was(79.8±22.6)d.In addition,1case(0.8%)had malunion in the early stage,but finally an acceptable alignment was obtained without additional operation.there was no delayed union,nonunion or shortening greater than 10 mm in the process of fracture healing.The average plaster fixation time was(31.7 ±19.0)days,and the average removal of internal fixation was(149.7 ± 26.7)days.The average cost of hospitalization and treatment was(20435.6 ±5631.9)yuan.The curative effect according to Johner-Wruh criteria for tibial fracture healing was excellent in 44 cases,good in 74 cases,fair in 5 cases and poor in 1 case.The excellent and good rate was 95.16%.Among them,1 child still had 13.0 degree valgus and 6.0 degree anteversion deformity until the evaluation of the curative effect,which was regarded as poor outcome according to the curative effect evaluation of Johner-Wruh tibial fracture.Among the 64 children in the calcaneal skeleton traction group,all achieved bony healing.The average fracture healing time was(69.6 ±16.0)d.The changes of imaging coronal angle and sagittal plane angle during fracture healing were(5.2 ±5.7)° and(3.4 ± 3.4)°,respectively.The average starting time of movement(Functional exercises)of the affected limb was(77.2±18.1)d.The average weight bearing time(Weight-bearing)of the affected limb was(92.5 ± 17.5)d.Malunion occurred in the early stage of fracture healing in 1 case(1.6%).The deformity was also recovered in the calcaneal skeleton traction group.There was no delayed union and nonunion in the calcaneal skeleton traction group.the average plaster fixation time was(43.1 ± 20.7)d,and the average time of pulling out the traction needle was 22.7d.The average cost of hospitalization and treatment was(8468.3 ± 2793.0)yuan.The curative effect according to Johner-Wruh criteria for tibial fracture healing was excellent in 22 cases,good in 34 cases,fair in 6 cases and poor in 0 cases.The excellent and good rate is 90.32%.There was no significant difference in the excellent and good rate between the two groups(P > 0.1),which indicated that there was no significant difference in the therapeutic effect between the two groups.Conclusion: Through comparative analysis in the two groups,calcaneal skeleton traction therapy has the advantages of minimally invasive,low cost,short operation time and so on,and more calcaneal traction can provide better imaging coronal correction results than elastic stable intramedullary nailing fixation.In addition,the calcaneal skeleton traction group had less postoperative malalignment(> 5 degree).However,the hospitalization time of children in elastic stable intramedullary nailing group was shorter,and the time of functional exercise and weight bearing in elastic stable intramedullary nailing group was earlier than that in calcaneal skeleton traction group.But overall,there was no significant difference in therapeutic efficacy and complications between the two groups.Therefore,when choosing the treatment method,we should not only consider the characteristics of the fracture of the children,but also take into account the fracture situation of the children and the wishes of their families. |
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