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Selected Publication:
Zwetti, T.
Long-term results of Salter Harris III and IV fractures of the lower extremity in children and adolescents
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] ; 2019. pp. 63
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- Authors Med Uni Graz:
- Advisor:
- Kraus Tanja
- Singer Georg
- Sorantin Erich
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- Abstract:
- Background: The main aim of this doctoral thesis was to retrospectively analyse a cohort of patients with Salter Harris III and IV fractures of the distal tibia treated at the Department of Paediatric and Adolescent Surgery of the Medical University of Graz and to evaluate their clinical and radiological long-term outcome. The secondary aim was to calculate the correlation between the different clinical and radiological scores. The hypothesis was that posttraumatic alterations of the articular cartilage seen on MRI correlate with clinical and radiological scores. Patients & Methods: All patients with Salter Harris III or IV fractures of the distal tibia treated between 2000 and 2012 were included and invited for a clinical and radiological (plain radiographs and MRI) follow-up examination. To evaluate clinical outcome the Weber score was applied. Osteoarthritis on plain radiographs was assessed using the Kellgren and Lawrence score. MRI were assessed using the modified Outerbridge classification. Correlations between radiological and clinical results were computed. Results: 60 patients with a mean age of 11 years (range 3-15 years) with 61 fractures (n=40 Salter Harris III, n=21 Salter Harris IV) were included of which 73.8% (n=45 fractures) were treated with cast immobilisation. In 3 (4.9%) of these cases closed reduction was additionally performed. The remaining 26.2% (n=16 fractures) underwent open reduction and internal fixation (ORIF). 18 of the patients were recruited for a radiological and clinical follow-up examination. Mean follow-up time was 109 months (range 48-184 months). The Weber score was very good for 6 (33.3%), good for 10 (55.6%) and poor for 2 patients (11.1%). The Kellgren and Lawrence score yielded grade 0 in 16 patients (88.9%) and grade 1 in 2 patients (11.1%). The modified Outerbridge classification (MRI based) yielded grade 0 for 13 patients (76.5%), grade 1 for 1 patient (5.9%), grade 2 for 2 patients (11.7%), and grade 3 for 1 patient (5.9%) and was associated with worse clinical outcome. Discussion: The present thesis shows predominantly good to excellent long-term outcome of Salter Harris III and IV fractures of the distal tibia in children and adolescents. We were able to show that a worse clinical result correlates with posttraumatic alterations of the articular surface on MRI.