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What Are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures? A Multicenter Study
Haley E Smith1,2, Aristides I Cruz1,2, R Justin Mistovich1,2
1All authors are listed in the Authors section at the end of this article.
Insights
Delayed surgery for tibial spine fractures (TSFs) is linked to increased meniscal injuries and longer procedures. Factors like delayed diagnosis and public insurance contribute to these delays in pediatric TSF treatment.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Sports Medicine
Background:
- Tibial spine fractures (TSFs) are uncommon, potentially leading to delayed diagnosis and treatment.
- The clinical outcomes associated with delayed surgical intervention for TSFs remain largely unknown.
Purpose of the Study:
- To identify risk factors associated with delayed surgical treatment of pediatric tibial spine fractures.
- To evaluate the outcomes of delayed surgical intervention in pediatric patients with TSFs.
Main Methods:
- Retrospective cohort study involving 368 pediatric patients with TSFs across 10 institutions (2000-2019).
- Surgery performed 21 days or more post-injury was defined as delayed.
- Multivariate regression analysis was used to adjust for confounding factors.
Main Results:
- Delayed surgery (≥21 days) was associated with higher odds of delayed diagnosis (≥1 week), multiple prior clinician visits, and delayed MRI (≥1 week).
- Patients undergoing delayed surgery had significantly higher rates of intraoperative meniscal injuries (42.3% vs 21.0%) and longer operative times (>2.5 hours).
- Delayed surgery combined with longer operative time (>2.5 hours) increased the odds of postoperative arthrofibrosis by 3.7 times.
Conclusions:
- Delayed surgical treatment of pediatric tibial spine fractures is associated with increased risk of meniscal injuries, prolonged operative duration, and postoperative arthrofibrosis.
- Factors such as delayed diagnosis, multiple clinician consultations, and public insurance correlate with delays in surgical treatment for TSFs.
Background:
The uncommon nature of tibial spine fractures (TSFs) may result in delayed diagnosis and treatment. The outcomes of delayed surgery are unknown.
Purpose:
To evaluate risk factors for, and outcomes of, delayed surgical treatment of pediatric TSFs.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
The authors performed a retrospective cohort study of TSFs treated surgically at 10 institutions between 2000 and 2019. Patient characteristics and preoperative data were collected, as were intraoperative information and postoperative complications. Surgery ≥21 days after injury was considered delayed based on visualized trends in the data. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounders.
Results:
A total of 368 patients (mean age, 11.7 ± 2.9 years) were included, 21.2% of whom underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF at ≥1 weeks after injury (95% CI, 1.1-14.3; P = .04), 2.1 times higher odds of having seen multiple clinicians before the treating surgeon (95% CI, 1.1-4.1; P = .03), 5.8 times higher odds of having magnetic resonance imaging (MRI) ≥1 weeks after injury (95% CI, 1.6-20.8; P < .007), and were 2.2 times more likely to have public insurance (95% CI, 1.3-3.9; P = .005). Meniscal injuries were encountered intraoperatively in 42.3% of patients with delayed surgery versus 21.0% of patients treated without delay (P < .001), resulting in 2.8 times higher odds in multivariate analysis (95% CI, 1.6-5.0; P < .001). Delayed surgery was also a risk factor for procedure duration >2.5 hours (odds ratio, 3.3; 95% CI, 1.4-7.9; P = .006). Patients who experienced delayed surgery and also had an operation >2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI, 1.1-12.5; P = .03).
Conclusion:
Patients who underwent delayed surgery for TSFs were found to have a higher rate of concomitant meniscal injury, longer procedure duration, and more postoperative arthrofibrosis when the surgery length was >2.5 hours. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery.
