Pediatrik Distal Tibia Fizis Yaralanmalarının Prognoz Analizi: Retrospektif, İki Merkezli Bir Çalışma

Öz

Giriş: Pediatrik distal tibia fizis kırıklarında kırık tipi, ilk deplasman miktarı, redüksiyon yöntemi, fibula kırığının eşlik etmesi ve travma mekanizmasının erken fizial duraksama üzerindeki etkilerini değerlendirmek. Materyal ve Yöntemler: Bu retrospektif çalışmaya 2019-2024 yılları arasında iki merkezde cerrahi tedavi uygulanmış 83 pediatrik distal tibia fizis kırığı olan hasta dahil edilmiştir. Kırık tipi (Salter-Harris sınıflaması, Mc.Farland, Tillaux, triplanar), redüksiyon yöntemi (açık/kapalı), fiksasyon tekniği ve yaralanma mekanizması gibi veriler analiz edilmiştir. Açısal deformiteler, lateral distal tibia açısı (LDTA) ve anterior distal tibia açısı (ADTA) kullanılarak değerlendirilmiştir. İstatistiksel analizler SPSS yazılımı ile gerçekleştirilmiş, anlamlılık düzeyi p<0.05 olarak kabul edilmiştir. Bulgular: Çalışmaya 59 erkek (%71) ve 24 kadın (%29) hasta dahil edilmiş olup, ortalama yaş 12 idi. Erken fizial kapanma 10 hastada (%12) gözlenmiş, en yüksek oranlar Salter-Harris tip 4 (%50) ve Mc.Farland kırıklarında (%50) tespit edilmiştir. McFarland kırıklarından birinde varus deformitesi gelişmiş ve düzeltici osteotomi uygulanmıştır. Distal tibia kırıkları arasında trafik kazasına bağlı yaralanmalar anlamlı olarak daha yüksek fizial kapanma oranlarıyla ilişkilendirilmiştir. Triplanar ve Tillaux kırıklarında fizial erken kapanma oranları sırasıyla %4.5 ve %12.5 olarak saptanmış ve literatür ile uyumlu bulunmuştur. Sonuç: Salter-Harris tip 4 ve Mc.Farland kırıkları ile yüksek enerjili travmalar, erken fizial kapanma için önemli risk faktörleridir. Bu bağlamda, hasta ailelerinin bilgilendirilmesi ve komplikasyonların erken tespiti için yakın takibin önemi büyüktür. Bulguların daha iyi anlaşılabilmesi için prospektif ve randomize çalışmalara ihtiyaç vardır. Anahtar Kelimeler: pediatrik, tibia kırığı, fizial yaralanma

Anahtar Kelimeler

• Pediatrik
• Tibia Kırığı
• fizial yaralanma

Pediatric Distal Tibial Physeal Injuries and Their Role in Premature Physeal Arrest: A Multi-Center Retrospective Study.

Öz

Aim: To evaluate the impact of factors such as fracture type, initial displacement, reduction method, associated fibular fractures, and trauma mechanism on the occurrence of premature physeal arrest in pediatric distal tibial physeal fractures. Methods: This retrospective study included 83 pediatric patients who underwent surgical treatment for distal tibial physeal fractures between 2019 and 2024 at two centers. Data on fracture type (Salter-Harris classification, Mc.Farland, tillaux, triplanar), reduction method (open/closed), fixation technique, and mechanism of injury were analyzed. Angular deformities were assessed using lateral distal tibial angle (LDTA) and anterior distal tibial angle (ADTA). Statistical analysis was performed using SPSS software, with significance set at p<0.05. Results: The cohort included 59 males (71%) and 24 females (29%) with a mean age of 12 years. Premature physeal closure was observed in 10 patients (12%), with higher rates in Salter-Harris type 4 (50%) and McFarland fractures (50%). One McFarland fracture resulted in varus deformity, necessitating corrective osteotomy. Among all distal tibial fractures, traffic accident-related injuries were significantly associated with higher rates of physeal arrest. The incidence of premature closure in triplanar and Tillaux fractures was 4.5% and 12.5%, respectively, consistent with literature data. Conclusion: Salter-Harris type 4 and McFarland fractures, as well as high-energy trauma, are significant risk factors for premature physeal arrest. Patient education and close follow-up are critical for early detection and management of complications. Prospective, randomized studies are warranted to further elucidate these findings. Keywords: pediatric, tibial fracture, physeal injury

Anahtar Kelimeler

• pediatric
• tibial fracture
• physeal injury

Kaynakça

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