WOFAPS 2025 8th World Congress of Pediatric Surgery

Zoltan Toth, Anna Lamberti, Tibor Molnar, Gergo Jozsa

Department of Paediatrics, Division of Paediatric Surgery, University of Pécs Medical School, Pécs, Hungary

Introduction: Knee wounds during childhood are frequent after falls. Proximal tibial injuries must be accurately diagnosed and treated to restore normal stability, strength, and range of motion to the limbs and prevent potential arthritis.

Aim: Our goal was to analyse the demographic data of children with proximal tibial fractures and to compare the efficiency of resorbable screws (Activascrew) to traditional metal fixation instruments (metal screws, K-wires and cerclages).

Patients and Methods: Consecutively 55 patients were evaluated from two Hungarian pediatric traumatology departments between January 2017 and September 2024 retrospectively. Age, sex, etiological and side distribution, severity, and the average length of hospital stays (LOS) were analysed. Complication rates along with the frequency of dislocations and combined injuries were also investigated.

Results: Predominantly boys (91% of all patients) were wounded with a mean age of 14.4 years (SD: 1.13, range: 12-17) and a Salter-Harris grade of 3.0 (SD: 0.78, range: 2-4). The right side of the patients was affected generally (69%), most commonly with epiphyseolysis (43.6% of cases), avulsion (38.2%), fracture of the tuberosity (18.2%), abruption (12.7%), or apophyseolysis of the proximal tibia (7.3%). These injuries were combined in 24% and dislocation of the fractures was observed in 54% of the patients. Eleven children were treated with resorbable screws who needed an average LOS of 3.72 days. Osteosynthesis of 12 patients with metal screws, K-wires and cerclages resulted in an initial LOS of 4.44 days, though the metal removal necessitated an additional day of care for traditional treatments. Metal screws and cerclages were employed in 10 patients, who had an average total LOS of 4.20 days. Solely metal screws were utilised in 12 children, who recuperated in 6.00 days, while in 12 patients, K-wire combined with cerclage required an overall 4.93 days of hospital stay.

Conclusions: Every evaluated intervention resulted in the expected outcome, as no complications were observed. Yet, other endpoints suggest a tendency for reduced hospitalisation connected to resorbable screws. Because there is no need for a metal removal operation, decreased anaesthetic use and overall treatment cost were also observed. Due to the lower number of interventions needed, children were less affected by distress and the healthcare professionals’ and operating theatres’ availability was improved.