Analysis of risk factors for re-displacement of pediatric tibia fractures: A retrospective study of 196 cases
Analysis of risk factors for re-displacement of pediatric tibia fractures: A retrospective study of 196 cases
Objective: The aims of this study were (1) to analyze the factors that may cause loss of reduction (LOR) in pediatric tibia diaphysis and distal third fractures treated with closed reduction and casting (CRC) and (2) to determine the effectiveness of cast index (CI), gap index (GI), and three-point index (TPI) in prediction of LOR. Methods: The patients aged 0-16 years who were admitted to the emergency department between January 2014 and January 2018, with tibia diaphysis or distal third fractures and treated with CRC were included the study. A total of 196 pediatric patients (41 females, 155 males) were retrospectively evaluated. The radiographs on admission were analyzed in terms of fracture type, location of the fracture, presence/location of the fibula fracture as well as initial angulation in both planes, translation, and the time of definitive cast. On radiographs taken after closed reduction and final casting, angulation in the coronal and sagittal planes, amount of translation (%), CI, GI, and TPI were measured. Logistic regression analysis was used to evaluate the risk factors of re-displacement. Results: Of 196 patients, 46 developed re-displacement (23%). Age (P : 0.029), initial translation (P : 0.006), post-reduction translation (P : 0.001), and post-reduction AP angulation (P : 0.002) were found statistically significant. Mean CI and GI were higher in re-displacement group (P : 0.033, 0.036, respectively). According to multivariate logistic regression analysis postreduction AP angulation, post-reduction translation, and cast index were found independent risk factors. Conclusion: One should carefully evaluate patients who underwent CRC due to tibia fracture with CI > 1.02, post-reduction AP angulation > 3.4°, and post-reduction translation > 24.3° in terms of occurrence of re-displacement.
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- 1. Raducha JE, Swarup I, Schachne JM, Cruz BAJr., Fabricant PD. Tibial shaft fractures in children and adolescents. J Bone Joint Surg Am. 2019;7(2):e4 .10. 2106/JBJS.RVW.18.00047
- 2. Ho CA. Tibia shaft fractures in adolescents: How and when can they be managed successfully with cast treatment? J Pediatr Orthop. 2016;36(Suppl 1):S15-S18. 10.1097/BPO.0000000000000762
- 3. Mashru RP, Herman MJ, Pizzutillo PD. Tibial shaft fractures in children and adolescents. J Am Acad Orthop Surg. 2005;13(5):345-352. 10.5435/00124635- 200509000-00008
- 4. Rickert KD, Hosseinzadeh P, Edmonds EW. What’s new in pediatric orthopaedic trauma: The lower extremity. J Pediatr Orthop. 2018;38(8):e434-e439. 10. 1097/BPO.0000000000001209
- 5. Chess DG, Hyndman JC, Leahey JL, Brown DC, Sinclair AM. Short arm plaster cast for distal pediatric forearm fractures. J Pediatr Orthop. 1994;14(2):211-213. 10.1097/01241398-199403000-00015
- 6. Malviya A, Tsintzas D, Mahawar K, Bache CE, Glithero PR. Gap index: A good predictor of failure of plaster cast in distal third radius fractures. J Pediatr Orthop B. 2007;16(1):48-52. 10.1097/01.bpb.0000236232.57269.ec
- 7. Alemdaroglu KB, Iltar S, Cimen O, et al. Risk factors in redisplacement of distal radial fractures in children. J Bone Joint Surg Am. 2008;90(6):1224-1230. 10. 2106/JBJS.G.00624
- 8. Turgut A, Erkuş S, Koca A, Payzıner L, Çiçek AO, Kalenderer O. Analysis of the factors causing tight cast syndrome after closed reduction and casting of pediatric distal radius fractures. Acta Orthop Traumatol Turc. 2018;52(5):329- 333. 10.1016/j.aott.2018.07.001
- 9. Alagöz E, Güleç MA. Factors affecting LOR in pediatric forearm fractures and the role of cast indices. Jt Dis Relat Surg. 2020;31(1):95-101. 10.5606/ehc.2020.71523
- 10. Hove LM, Brudvik C. Displaced paediatric fractures of the distal radius. Arch Orthop Trauma Surg. 2008;128:55-60. 10.1007/s00402-007-0473-x
- 11. Ho CA, Dammann G, Podeszwa DA, Levy J. Tibial shaft fractures in adolescents: Analysis of cast treatment successes and failures. J Pediatr Orthop B. 2015;24(2):114-117. 10.1097/BPB.0000000000000144
- 12. Kinney MC, Nagle D, Bastrom T, Linn MS, Schwartz AK, Pennock AT. Operative versus conservative management of displaced tibial shaft fracture in adolescents. J Pediatr Orthop. 2016;36(7):661-666. 10.1097/BPO. 0000000000000532
- 13. Öztürk A, Arican G, Demir K, Şibar K, Ö E, Alemdaroğlu KB. Risk factors for failure of cast treatment in displaced pediatric tibial shaft fractures. J Pediatr Orthop. 2021;41(3):e252-e258. 10.1097/BPO.0000000000001743
- 14. Gordon JE, Gregush RV, Schoenecker PL, Dobbs MB, Luhmann SJ. Complications after titanium elastic nailing of pediatric tibial fractures. J Pediatr Orthop. 2007;27:442-446. 10.1097/01.bpb.0000271333.66019.5c
- 15. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation 255 coefficients for reliability research. J Chiropr Med. 2016;15(2):155-163. 10. 1016/j.jcm.2016.02.012
- 16. Canavese F, Botnari A, Andreacchio A, et al. Displaced tibial shaft fractures with intact fibula in children: Nonoperative management versus operative treatment with elastic stable intramedullary nailing. J Pediatr Orthop. 2016;36 (7):667-672. 10.1097/BPO.0000000000000528
- 17. Yang JP, Letts RM. Isolated fractures of the tibia with intact fibula in children: A review of 85 patients. J Pediatr Orthop. 1997;17:347-351. 10.1097/01241398- 199705000-00015
- 18. Stenroos A, Laaksonen T, Nietosvaara N, Jalkanen J, Nietosvaara Y. One in three of pediatric tibia shaft fractures is currently treated operatively: A 6-year epidemiological study in two university hospitals in Finland treatment of pediatric tibia shaft fractures. Scand J Surg. 2018;107(3):269-274. 10.1177/ 1457496917748227
- 19. Shalabh K, Ajai S, Vineet K, Sabir A. Are gap and cast indices predictors of efficacy of reduction in fractures of both bones of the Leg? A cohort study. Malays Orthop J. 2018;12(2):15-19. 10.5704/MOJ.1807.003
- 20. Briggs TW, Orr MM, Lightowler CD. Isolated tibial fractures in children. Injury. 1992;23(5):308-310. 10.1016/0020-1383(92)90175-R