What are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures?

• Published in: Orthopaedic journal of sports medicine 2022-05, Vol.10 (5_suppl2)
• Main Authors: Patel, Neeraj M., Leska, Tomasina M., Ganley, Theodore J., Aoyama, Julien T., Cruz, Aristides I., Ellis, Henry B., Fabricant, Peter D., Green, Daniel W., Jagodzinski, Jason E., Johnson, Benjamin, Kushare, Indranil, Lee, Rushyuan J., McKay, Scott D., Rhodes, Jason T., Sachleben, Brant C., Sargent, M. Catherine, Schmale, Gregory A., Yen, Yi-Meng, Mistovich, R. Justin
• Format: Article
• Language: English
• Subjects: Magnetic resonance imaging; Orthopedics; Pediatrics; Sports medicine; Surgery
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/2325967121S00520

Background: The uncommon nature of tibial spine fractures may result in delayed presentation, diagnosis, and treatment. Elucidation of the contributing factors to such delays may provide an opportunity to improve patient care. Additionally, the outcomes of delayed surgery are unknown. Hypothesis/Purpose: The purpose of this study is to evaluate risk factors for, and consequences of, delayed surgical treatment of pediatric tibial spine fractures. Methods: We performed a retrospective cohort study of tibial spine fractures treated surgically at 10 institutions between 2000 and 2019. Demographic and pre-operative data were collected, as was intra-operative information and post-operative complications. Attention was focused on delays in evaluation and treatment, which were treated as both continuous and categorical variables. Surgery ≥21 days after injury was considered “delayed”. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 368 subjects (mean age 11.7±2.9 years) were included, 21.2% of which underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF 1 or more weeks after injury [95% confidence interval (CI) 1.1-14.3, p=0.04], 2.3 times higher odds of having seen multiple clinicians prior to the treating surgeon (95% CI 1.1-4.8, p=0.02), 5.8 times higher odds of having magnetic resonance imaging 1 or more weeks after injury (MRI; 95% CI 1.6-20.8, p