DISTAL TIBIAL EPIPHYSEAL FRACTURES
Autori:
Anko Antabak, Marija Perko, Dino Papeš, Krešimir Bulić, Marko Bogović, Tomislav Luetić, Stanko Ćavar, Goran Augustin, Tomo Kovač, Renato Ivelj, Filip Jurić
Sažetak
Ozljeda epifizne ploče rasta (epifizeoliza) jedan je od prijeloma koji nalažu posebnu pozornost. Glavne su mu značajke velika pojavnost i neizvjestan ishod. Unatoč ispravnoj dijagnostici i liječenju epifizeolize distalne tibije mogu nastati teške komplikacije (zastoj uzdužnog rasta i/ili progresivna deformacija). Budući da su kurativne metode nemoćne kod težih oblika epifizeoliza, preventivnim mjerama treba barem ublažiti težinu i smanjiti pojavnost ovih ozljeda. Pojavnost i tip prijeloma u djece uvjetovani su brojnim čimbenicima (dob, spol, pretežito ponašanje djece, karakteristika mjesta na kojima djeca borave...), a razlikuju se ne samo od regije do regije već i od grada do grada. U ovom radu analizirano je 197-ero zagrebačke djece koja su od 1. 1. 2010. do 1. 1. 2017. liječena zbog ozljede distalne epifize tibije. Zbog nepotpunih podataka iz studije je isključeno 80-ero djece. Ukupno je analizirano 117-ero zagrebačke djece. Njih 37-ero liječeno je u Kliničkome bolničkom centru Zagreb, a 80-ero u Klinici za dječje bolesti Zagreb. U ispitanom uzorku bilo je 88 (69,2%) dječaka i 29 (30,8%) djevojčica. Srednja dob u trenutku ozljeđivanja bila je 12,3 godine, pri čemu su dječaci bili u prosjeku 17 mjeseci stariji od djevojčica. Prema mehanizmima ozljede, većinom se radilo o padovima (58 (49,9%)), a kao najčešća mjesta izdvajaju se sportske površine (36 (30,8%)) te kod kuće (27 (23,1%)). Prema šifri aktivnosti, najčešće su rekreativne (52 (44,4%)) i sportske aktivnosti (47 (40,2%)). Najčešća sportska aktivnost je igranje nogometa. Stoga preventivne mjere treba usmjeriti ponajprije na mušku djecu školske dobi, tijekom sportskih i rekreativnih izvanškolskih aktivnosti, posebice u nogometu.
Summary
Distal tibial epiphyseal fractures are significant because they often cause tibial growth disturbance. Distal tibial epiphyseal fractures are the second most common epiphyseal fractures, after distal radial epiphysis. Despite prompt diagnosis and correct treatment, serious complications, such as progressive deformation and permanent disability, are possible. Therefore, it is necessary to prevent these injuries. Prevention is possible only by studying injury pattern, mechanism and locations where fractures occur. In total, medical records of 197 children treated for distal tibia epiphyseal fracture in the period from January 1st , 2010 to January 1st , 2017 were analyzed. Due to insufficient data, 80 of them were excluded from the study. Thirty-seven children were treated in Clinical Hospital Center Zagreb and eighty in the Children’s Hospital Zagreb. In the studied group of children, there were 81 (69.2%) boys and 36 (30.8%) girls. The average age at the time of injury was 12.3 years, with boys being on average 17 months older than girls. ICD 10 classification was used. The most common mechanism of injury was falling, in 90 cases (76.9%). Sport grounds were the most common location where injuries occurred, in 36 cases (30.8%), while the household was the second most common, 27 (23.1%) cases. The most common activities during which injuries occurred were leisure activities, in 52 (44.4%) patients, and sports in 47 (40.2%) patients. The most common activity during which distal tibial epiphyseal fractures occurred was football and leisure activities on inadequate sport grounds. Prevention measures should mainly focus on the sports activities in children aged between 10 and 16 years.
