In this study, we tried to apply a unilateral external fixator combined with joystick for fracture reduction in the treatment of pediatric tibia shaft fractures. Translational orthopedics is that new orthopedic technique which is efficiently transformed from the scientist to the clinician. But there are still few studies on the use of external fixation to treat tibia shaft fractures in children, and a mature treatment system has not been formed. With regard to external fixation, it is deemed as a primary and effective treatment for pediatric tibia shaft fractures despite the complications. Additionally, TEN can cause secondary surgery to remove internal fixation as well. However, its fixation strength is reduced for other fracture types such as long oblique or spiral fractures, and it needs to be combined with external fixation with a brace, thereby influencing early functional exercise. In practical application, TEN is most suitable for transverse or short oblique fractures. Previous studies have demonstrated that TEN is beneficial for the treatment of pediatric tibia shaft fractures. , which was quickly accepted and promoted for use in pediatric tibia shaft fractures. ![]() TEN has been first reported in 1988 by Ligier et al. ![]() Therefore, the minimally invasive surgical treatment of pediatric tibia shaft fractures is urgent. At the same time, the inevitable surgery to remove internal fixation will cause secondary injury to the child. Despite the development of these surgery methods, open reduction and internal fixation has several disadvantages including large trauma, destruction of blood supply, and increases the risk of bone nonunion and infection. Recently, the surgical approaches for treating tibia shift fractures include external fixation, titanium elastic nail (TEN), and open reduction and internal fixation. However, for significantly displaced tibia fractures, surgical treatment should be considered to avoid sequelae caused by shortening, rotation, or severe force line changes. Since pediatric fractures with characteristics of faster healing and strong shaping ability, cast external fixation was treated for was tibia shaft fractures with insignificant displacement, which achieved satisfactory outcomes, especially for greenstick fractures. Tibia fracture is a common injury in children accounting for 15% of children’s fractures, and 40% of tibia fractures are located in the middle of the tibia. It may provide a new choice for children with tibia shaft fractures who require surgical treatment. This procedure had advantages of simple operation, minimum trauma, early recovery of lower limb function, and no risk of complications. The Johner-Wruh scores showed that 21 cases (91.3%) were “excellent” and 2 cases (8.7%) were “good.” Conclusions No complications including fixation failure, reoperation, epiphyseal injury occurred, infection around implants, vessel damage, nerve damage, and limitation of joint movement were observed. All patients achieved fracture healing and good functional recovery. The average time to full weight-bearing without crutches was 5.1 weeks (ranged 3–8 weeks). Of these, 2 cases showed redness and swelling of pin-tract and exudation at postoperative 1 month, who improved after oral antibiotics without causing fixation failure. At postoperative 3 days, the visual analog scale (VAS) score was 3.1 ± 1.43, which was significantly lower than the preoperative score of 7.3 ± 1.5. The average duration of hospital and follow-up were 5.9 days (ranged 4–8 days) and 17.4 months (ranged 8–27 months), respectively. ![]() ResultsĪ total of 23 patients were included in the current study with the average age of 8.0 years (ranged 4–14 years). We retrospectively analyzed the patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction between July 2018 and March 2020. ![]() The aims of current study were to present the clinical outcomes in patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction and describe the details of our technique.
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