Pediatrik ayak bileği kırıklarında klinik sonuç, maliyet ve kaynama sürelerinin karşılaştırılması

Year 2025, Volume: 8 Issue: 5, 832 - 838, 16.09.2025

Okan Ateş , Mustafa Altıntaş

https://doi.org/10.32322/jhsm.1732198

Abstract

Amaç: Bu çalışmanın amacı, pediatrik hastalarda ayak bileği çevresi kırıklarında kırık tipi ve kullanılan implantların fonksiyonel sonuçlar, kaynama süresi, hastanede yatış süresi ve maliyet üzerindeki etkilerini değerlendirmektir.
Yöntem: 2017–2023 yılları arasında ayak bileği kırığı nedeniyle opere edilen toplam 58 olgu retrospektif olarak incelendi. Birinci grupta izole malleol kırıkları olan hastalar, ikinci grupta bimalleolar veya trimalleolar kırıkları olan hastalar, üçüncü grupta distal tibia kırıkları olan hastalar ve dördüncü grupta lateral malleol kırığıyla ile distal tibia kırıkları olan hastalar yer aldı. Kullanılan implanta göre hastalar beş grupta sınıflandırıldı: K teli, kanüllü vida, plak vida, kanüllü vida + plak vida ve kanüllü vida + plak vida + eksternal fiksatör.
Bulgular: İzole malleol kırığı olan hastalarda hastanede yatış süresi istatistiksel olarak anlamlı şekilde daha kısa bulundu (p=0,042). Aynı grupta kırık kaynama süresi de anlamlı düzeyde daha kısa idi (p=0,023). Tanıya göre yapılan maliyet analizinde; izole malleol kırıklarında 100–300 $ arası maliyetler daha yaygınken, distal tibia kırıklarında >300 $ maliyetler daha sık görüldü (p=0,001). İyileşme sonrası AOFAS (American Orthopaedic Foot & Ankle Society) skorları, izole malleol kırığı grubunda bimalleoler/trimalleoler ve distal tibia kırığı gruplarına kıyasla anlamlı düzeyde daha yüksekti (p=0,001). Beş implant grubunun karşılaştırmasında, kanüllü vida + plak vida + fiksatör grubunda ortalama kaynama süresi istatistiksel olarak anlamlı düzeyde daha uzundu (p=0,0001). Plak vida grubunda da kaynama süresi, K teli ve kanüllü vida gruplarına göre anlamlı şekilde daha uzundu (p=0,002 ve p=0,0001). Diğer gruplar arasında istatistiksel olarak anlamlı fark gözlenmedi (p>0,05). İyileşme sonrası AOFAS skorları, K teli grubunda plak vida ve kanüllü vida + plak vida + fiksatör gruplarına göre anlamlı düzeyde daha yüksek bulundu (p=0,018).
Sonuç: İzole malleol kırıkları, travmanın daha minör olması nedeniyle daha kısa hastanede yatış süresi, daha hızlı kaynama süresi, daha iyi fonksiyonel sonuçlar ve daha düşük implant maliyeti ile seyretmektedir. Distal tibia kırıklarında implant maliyeti daha yüksek olmasına rağmen, diğer klinik sonuçlar benzer bulunmuştur.

Keywords

Ayak bileği kırığı , maliyet analizi , cerrahi sonuçlar , pediatrik travma

Comparison of clinical outcome, cost and union times in pediatric ankle fractures

Abstract

Aims: The aim of this study was to evaluate the effects of fracture type and implant used in ankle-related fractures in pediatric patients on functional outcome, union time, hospital stay and cost.
Methods: A total of 58 cases operated on due to ankle fractures between 2017 and 2023 were reviewed. Patients were divided into 4 groups according to diagnosis. The first group included patients with isolated malleolus fractures, the second group included patients with bimalleolar or trimalleolar fractures, the third group included patients with distal tibia fractures, and the fourth group included patients with distal tibia fractures with a lateral malleolus. Patients were divided into five groups according to the implants used. These were determined as: K-wire, cannulated screw, plate screw, cannulated screw and plate screw, cannulated screw and plate screw+fixator. Demographic characteristics, union times, implant costs, and the American Orthopaedic Foot and Ankle Society (AOFAS) score were examined between the groups.
Results: Union time was significantly shorter in patients with isolated malleolar fractures compared to other groups (p=0.042). Cost analysis by diagnosis showed that costs in the range of $100-300 were more common in isolated malleolar fractures, whereas costs exceeding $300 were more common in distal tibia fractures (p=0.001). Post-recovery AOFAS (American Orthopaedic Foot & Ankle Society) scores were significantly higher in the isolated malleolar fracture group compared to the bimalleolar/trimalleolar and distal tibia fracture groups (p=0.001). Comparison between all groups; implant comparison, the mean union time (in months) was significantly longer in the cannulated screw+plate and screw+fixator group compared to the K-wire, cannulated screw, plate and screw, and cannulated screw+plate and screw groups (p=0.0001). The plate and screw group also had significantly longer union times than the K-wire and cannulated screw groups (p=0.002, p=0.0001). Post-recovery AOFAS scores were significantly higher in the K-wire group compared to the plate and screw and cannulated screw+plate and screw+fixator groups (p=0.018).
Conclusion: In isolated malleolar fractures, due to the more minor nature of the trauma, shorter hospital stays, quicker fracture union, better functional outcomes, and lower implant costs were observed. Implant costs did not affect functional outcomes or time to union.

Keywords

Ankle fracture , cost analysis , surgical outcomes , pediatric trauma

References

• Cruz AI, Raducha JE, Swarup I, Schachne JM, Fabricant PD. Evidence-based update on the surgical treatment of pediatric tibial shaft fractures. Curr Opin Pediatr. 2019;31(1):92-102. doi:10.1097/MOP.00000 00000000704
• Su AW, Larson AN. Pediatric ankle fractures: concepts and treatment principles. Foot Ankle Clin. 2015;20(4):705-719. doi:10.1016/j.fcl.2015. 07.004
• Cancino B, Sepúlveda M, Birrer E. Ankle fractures in children. EFORT Open Rev. 2021;6(7):593-606. doi:10.1302/2058-5241.6.200042
• Olgun ZD, Maestre S. Management of pediatric ankle fractures. Curr Rev Musculoskelet Med. 2018;11(3):475-484. doi:10.1007/s12178-018-9510-3
• Cancino B, Sepúlveda M, Birrer E. Ankle fractures in children. EFORT Open Rev. 2021;6(7):593-606. doi:10.1302/2058-5241.6.200042
• Belatti DA, Phisitkul P. Economic burden of foot and ankle surgery in the US Medicare population. Foot Ankle Int. 2014;35(4):334-340. doi:10. 1177/1071100713519777
• Rainey M, Ramirez C, Dayoub E, Sanchez D, Childs B, Bacak C. The economic ramifications of pediatric distal tibial physeal fractures. J Orthopaed Business. 2025;5:1.
• Madeley NJ, Wing KJ, Topliss C, Penner MJ, Glazebrook MA, Younger AS. Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS ankle hindfoot score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int. 2012;33(1):57-63. doi:10.3113/FAI. 2012.0057
• Verhage SM, Schipper IB, Hoogendoorn JM. Long-term functional and radiographic outcomes in 243 operated ankle fractures. J Foot Ankle Res. 2015;8(1):45. doi:10.1186/s13047-015-0098-1
• Pina G, Fonseca F, Vaz A, Carvalho A, Borralho N. Unstable malleolar ankle fractures: evaluation of prognostic factors and sports return. Arch Orthop Trauma Surg. 2021;141(1):99-104. doi:10.1007/s00402-020-03650-w
• Broos PLO, Bisschop APG. Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. Injury. 1991;22(5):403-406. doi:10.1016/0020-1383(91)90106-O
• Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egol KA. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Joint Surg. 2007;89(7):1438-1441. doi:10.2106/JBJS.F.01006
• Keny SM. Pediatric and adolescent ankle fractures: current concepts and advances in management. J Clin Orthopaed. 2024;9(2):44-46. doi: 10.13107/jcorth.2024.v09i02.660
• Talaski GM, Sleem B, Luo EJ, et al. Diagnosis, treatment, and potential complications of triplane ankle fractures in pediatric patients: a systematic review. J Clin Med. 2025;14(5):1578. doi:10.3390/jcm14051578
• Kang H, Kang T, Lim C. The incidence and treatment outcome of atypical triplane fractures in adolescents. Indian J Orthop. 2022;56(12):2133-2140. doi:10.1007/s43465-022-00679-4
• Ayas MS, Kalkışım M, Turgut MC, et al. Analysis of clinical outcomes in pediatric distal tibia triplanar fractures treated surgically and conservatively. Cureus. 2021;13(12):e20723. doi:10.7759/cureus.20723
• Roberts V, Mason LW, Harrison E, Molloy AP, Mangwani J. Does functional outcome depend on the quality of the fracture fixation? Mid to long term outcomes of ankle fractures at two university teaching hospitals. Foot Ankle Surg. 2019;25(4):538-541. doi:10.1016/j.fas.2018.04. 008
• Dias LS, Tachdjian MO. Physeal injuries of the ankle in children: classification. Clin Orthop Relat Res. 1978;(136):230-233.
• Venkatadass K, Sangeet G, Prasad VD, Rajasekaran S. Paediatric ankle fractures: guidelines to management. Indian J Orthop. 2021;55(1):35-46. doi:10.1007/s43465-020-00270-9
• Onay T, Çelen ZE, Bayhan M, Kandemir İ, Kiliç NC, Kayaalp ME. A more conservative approach in the surgical management of pediatric physeal ankle fractures should be preferred: mid to long-term functional outcomes of three different surgical techniques for salter-harris type II and triplane distal tibial fractures. J Pediatr Orthop. 2023;43(9): e734-e741. doi:10.1097/BPO.0000000000002471
• Stull JD, Bhat SB, Kane JM, Raikin SM. Economic burden of ınpatient admission of ankle fractures. Foot Ankle Int. 2017;38(9):997-1004. doi: 10.1177/1071100717709576