Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model

Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Orthopaedic journal of sports medicine 2019-08, Vol.7 (8), p.2325967119866162-2325967119866162
Hauptverfasser: Adams, Alexander J., O’Hara, Nathan N., Abzug, Joshua M., Aoyama, Julien T., Ganley, Theodore J., Carey, James L., Cruz, Aristides I., Ellis, Henry B., Fabricant, Peter D., Green, Daniel W., Heyworth, Benton E., Janicki, Joseph A., Kocher, Mininder S., Lawrence, John T.R., Lee, R. Jay, McKay, Scott D., Mistovich, R. Justin, Patel, Neeraj M., Polousky, John D., Rhodes, Jason T., Sachleben, Brant C., Sargent, M. Catherine, Schmale, Gregory A., Shea, Kevin G., Yen, Yi-Meng
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 2325967119866162
container_issue 8
container_start_page 2325967119866162
container_title Orthopaedic journal of sports medicine
container_volume 7
creator Adams, Alexander J.
O’Hara, Nathan N.
Abzug, Joshua M.
Aoyama, Julien T.
Ganley, Theodore J.
Carey, James L.
Cruz, Aristides I.
Ellis, Henry B.
Fabricant, Peter D.
Green, Daniel W.
Heyworth, Benton E.
Janicki, Joseph A.
Kocher, Mininder S.
Lawrence, John T.R.
Lee, R. Jay
McKay, Scott D.
Mistovich, R. Justin
Patel, Neeraj M.
Polousky, John D.
Rhodes, Jason T.
Sachleben, Brant C.
Sargent, M. Catherine
Schmale, Gregory A.
Shea, Kevin G.
Yen, Yi-Meng
description Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P < .001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P = .01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversia
doi_str_mv 10.1177/2325967119866162
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6713965</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_2325967119866162</sage_id><sourcerecordid>2286932154</sourcerecordid><originalsourceid>FETCH-LOGICAL-c462t-8e0d8b889dc8811807cb7a7a2a614af181fa766b14c4c2b5a196cd25fa8f6a013</originalsourceid><addsrcrecordid>eNp1kUFr3DAQhU1paUKae05F0EsvTj2SLck9FMKSNAsJCXRLjmIsj3cVvPZWkkP231fLpmkaqC4jRt-8mdHLshMoTgGU-sIFr2qpAGotJUj-JjvcpfJd7u2L-0F2HMJ9kY6uoBbqfXYgoNS1EOVh5m6pdRi9s2yx3RCbz9nCNQ579mPjBmIXHm2cPIWv7KxtUwxuWLK4IrbwhHFNQ2SzcYh-fCAftuzOxRVDdu0eqc3Pu45sDOx6bKn_kL3rsA90_BSPsp8X54vZZX51830-O7vKbSl5zDUVrW60rlurNYAulG0UKuQoocQONHSopGygtKXlTYVQS9vyqkPdSSxAHGXf9rqbqVlTa9OEHnuz8W6NfmtGdObfl8GtzHJ8MOmrRC2rJPD5ScCPvyYK0axdsNT3ONA4BcO5lrXgUJUJ_fQKvR8nP6T1DBcglAZZ8UQVe8r6MQRP3fMwUJidlea1lank48slngv-GJeAfA8EXNLfrv8V_A1pYaYv</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2313781652</pqid></control><display><type>article</type><title>Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model</title><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>SAGE Journals</source><creator>Adams, Alexander J. ; O’Hara, Nathan N. ; Abzug, Joshua M. ; Aoyama, Julien T. ; Ganley, Theodore J. ; Carey, James L. ; Cruz, Aristides I. ; Ellis, Henry B. ; Fabricant, Peter D. ; Green, Daniel W. ; Heyworth, Benton E. ; Janicki, Joseph A. ; Kocher, Mininder S. ; Lawrence, John T.R. ; Lee, R. Jay ; McKay, Scott D. ; Mistovich, R. Justin ; Patel, Neeraj M. ; Polousky, John D. ; Rhodes, Jason T. ; Sachleben, Brant C. ; Sargent, M. Catherine ; Schmale, Gregory A. ; Shea, Kevin G. ; Yen, Yi-Meng</creator><creatorcontrib>Adams, Alexander J. ; O’Hara, Nathan N. ; Abzug, Joshua M. ; Aoyama, Julien T. ; Ganley, Theodore J. ; Carey, James L. ; Cruz, Aristides I. ; Ellis, Henry B. ; Fabricant, Peter D. ; Green, Daniel W. ; Heyworth, Benton E. ; Janicki, Joseph A. ; Kocher, Mininder S. ; Lawrence, John T.R. ; Lee, R. Jay ; McKay, Scott D. ; Mistovich, R. Justin ; Patel, Neeraj M. ; Polousky, John D. ; Rhodes, Jason T. ; Sachleben, Brant C. ; Sargent, M. Catherine ; Schmale, Gregory A. ; Shea, Kevin G. ; Yen, Yi-Meng ; Tibial Spine Research Group ; Tibial Spine Research Group</creatorcontrib><description>Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P &lt; .001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P = .01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.</description><identifier>ISSN: 2325-9671</identifier><identifier>EISSN: 2325-9671</identifier><identifier>DOI: 10.1177/2325967119866162</identifier><identifier>PMID: 31489334</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Decision making ; Orthopedics ; Pediatrics ; Sports medicine ; Surgeons</subject><ispartof>Orthopaedic journal of sports medicine, 2019-08, Vol.7 (8), p.2325967119866162-2325967119866162</ispartof><rights>The Author(s) 2019</rights><rights>The Author(s) 2019. This work is licensed under the Creative Commons Attribution – Non-Commercial – No Derivatives License http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2019 2019 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-8e0d8b889dc8811807cb7a7a2a614af181fa766b14c4c2b5a196cd25fa8f6a013</citedby><cites>FETCH-LOGICAL-c462t-8e0d8b889dc8811807cb7a7a2a614af181fa766b14c4c2b5a196cd25fa8f6a013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713965/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713965/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,21966,27853,27924,27925,44945,45333,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31489334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Adams, Alexander J.</creatorcontrib><creatorcontrib>O’Hara, Nathan N.</creatorcontrib><creatorcontrib>Abzug, Joshua M.</creatorcontrib><creatorcontrib>Aoyama, Julien T.</creatorcontrib><creatorcontrib>Ganley, Theodore J.</creatorcontrib><creatorcontrib>Carey, James L.</creatorcontrib><creatorcontrib>Cruz, Aristides I.</creatorcontrib><creatorcontrib>Ellis, Henry B.</creatorcontrib><creatorcontrib>Fabricant, Peter D.</creatorcontrib><creatorcontrib>Green, Daniel W.</creatorcontrib><creatorcontrib>Heyworth, Benton E.</creatorcontrib><creatorcontrib>Janicki, Joseph A.</creatorcontrib><creatorcontrib>Kocher, Mininder S.</creatorcontrib><creatorcontrib>Lawrence, John T.R.</creatorcontrib><creatorcontrib>Lee, R. Jay</creatorcontrib><creatorcontrib>McKay, Scott D.</creatorcontrib><creatorcontrib>Mistovich, R. Justin</creatorcontrib><creatorcontrib>Patel, Neeraj M.</creatorcontrib><creatorcontrib>Polousky, John D.</creatorcontrib><creatorcontrib>Rhodes, Jason T.</creatorcontrib><creatorcontrib>Sachleben, Brant C.</creatorcontrib><creatorcontrib>Sargent, M. Catherine</creatorcontrib><creatorcontrib>Schmale, Gregory A.</creatorcontrib><creatorcontrib>Shea, Kevin G.</creatorcontrib><creatorcontrib>Yen, Yi-Meng</creatorcontrib><creatorcontrib>Tibial Spine Research Group</creatorcontrib><creatorcontrib>Tibial Spine Research Group</creatorcontrib><title>Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model</title><title>Orthopaedic journal of sports medicine</title><addtitle>Orthop J Sports Med</addtitle><description>Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P &lt; .001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P = .01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.</description><subject>Decision making</subject><subject>Orthopedics</subject><subject>Pediatrics</subject><subject>Sports medicine</subject><subject>Surgeons</subject><issn>2325-9671</issn><issn>2325-9671</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kUFr3DAQhU1paUKae05F0EsvTj2SLck9FMKSNAsJCXRLjmIsj3cVvPZWkkP231fLpmkaqC4jRt-8mdHLshMoTgGU-sIFr2qpAGotJUj-JjvcpfJd7u2L-0F2HMJ9kY6uoBbqfXYgoNS1EOVh5m6pdRi9s2yx3RCbz9nCNQ579mPjBmIXHm2cPIWv7KxtUwxuWLK4IrbwhHFNQ2SzcYh-fCAftuzOxRVDdu0eqc3Pu45sDOx6bKn_kL3rsA90_BSPsp8X54vZZX51830-O7vKbSl5zDUVrW60rlurNYAulG0UKuQoocQONHSopGygtKXlTYVQS9vyqkPdSSxAHGXf9rqbqVlTa9OEHnuz8W6NfmtGdObfl8GtzHJ8MOmrRC2rJPD5ScCPvyYK0axdsNT3ONA4BcO5lrXgUJUJ_fQKvR8nP6T1DBcglAZZ8UQVe8r6MQRP3fMwUJidlea1lank48slngv-GJeAfA8EXNLfrv8V_A1pYaYv</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Adams, Alexander J.</creator><creator>O’Hara, Nathan N.</creator><creator>Abzug, Joshua M.</creator><creator>Aoyama, Julien T.</creator><creator>Ganley, Theodore J.</creator><creator>Carey, James L.</creator><creator>Cruz, Aristides I.</creator><creator>Ellis, Henry B.</creator><creator>Fabricant, Peter D.</creator><creator>Green, Daniel W.</creator><creator>Heyworth, Benton E.</creator><creator>Janicki, Joseph A.</creator><creator>Kocher, Mininder S.</creator><creator>Lawrence, John T.R.</creator><creator>Lee, R. Jay</creator><creator>McKay, Scott D.</creator><creator>Mistovich, R. Justin</creator><creator>Patel, Neeraj M.</creator><creator>Polousky, John D.</creator><creator>Rhodes, Jason T.</creator><creator>Sachleben, Brant C.</creator><creator>Sargent, M. Catherine</creator><creator>Schmale, Gregory A.</creator><creator>Shea, Kevin G.</creator><creator>Yen, Yi-Meng</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190801</creationdate><title>Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model</title><author>Adams, Alexander J. ; O’Hara, Nathan N. ; Abzug, Joshua M. ; Aoyama, Julien T. ; Ganley, Theodore J. ; Carey, James L. ; Cruz, Aristides I. ; Ellis, Henry B. ; Fabricant, Peter D. ; Green, Daniel W. ; Heyworth, Benton E. ; Janicki, Joseph A. ; Kocher, Mininder S. ; Lawrence, John T.R. ; Lee, R. Jay ; McKay, Scott D. ; Mistovich, R. Justin ; Patel, Neeraj M. ; Polousky, John D. ; Rhodes, Jason T. ; Sachleben, Brant C. ; Sargent, M. Catherine ; Schmale, Gregory A. ; Shea, Kevin G. ; Yen, Yi-Meng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-8e0d8b889dc8811807cb7a7a2a614af181fa766b14c4c2b5a196cd25fa8f6a013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Decision making</topic><topic>Orthopedics</topic><topic>Pediatrics</topic><topic>Sports medicine</topic><topic>Surgeons</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adams, Alexander J.</creatorcontrib><creatorcontrib>O’Hara, Nathan N.</creatorcontrib><creatorcontrib>Abzug, Joshua M.</creatorcontrib><creatorcontrib>Aoyama, Julien T.</creatorcontrib><creatorcontrib>Ganley, Theodore J.</creatorcontrib><creatorcontrib>Carey, James L.</creatorcontrib><creatorcontrib>Cruz, Aristides I.</creatorcontrib><creatorcontrib>Ellis, Henry B.</creatorcontrib><creatorcontrib>Fabricant, Peter D.</creatorcontrib><creatorcontrib>Green, Daniel W.</creatorcontrib><creatorcontrib>Heyworth, Benton E.</creatorcontrib><creatorcontrib>Janicki, Joseph A.</creatorcontrib><creatorcontrib>Kocher, Mininder S.</creatorcontrib><creatorcontrib>Lawrence, John T.R.</creatorcontrib><creatorcontrib>Lee, R. Jay</creatorcontrib><creatorcontrib>McKay, Scott D.</creatorcontrib><creatorcontrib>Mistovich, R. Justin</creatorcontrib><creatorcontrib>Patel, Neeraj M.</creatorcontrib><creatorcontrib>Polousky, John D.</creatorcontrib><creatorcontrib>Rhodes, Jason T.</creatorcontrib><creatorcontrib>Sachleben, Brant C.</creatorcontrib><creatorcontrib>Sargent, M. Catherine</creatorcontrib><creatorcontrib>Schmale, Gregory A.</creatorcontrib><creatorcontrib>Shea, Kevin G.</creatorcontrib><creatorcontrib>Yen, Yi-Meng</creatorcontrib><creatorcontrib>Tibial Spine Research Group</creatorcontrib><creatorcontrib>Tibial Spine Research Group</creatorcontrib><collection>SAGE Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Orthopaedic journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adams, Alexander J.</au><au>O’Hara, Nathan N.</au><au>Abzug, Joshua M.</au><au>Aoyama, Julien T.</au><au>Ganley, Theodore J.</au><au>Carey, James L.</au><au>Cruz, Aristides I.</au><au>Ellis, Henry B.</au><au>Fabricant, Peter D.</au><au>Green, Daniel W.</au><au>Heyworth, Benton E.</au><au>Janicki, Joseph A.</au><au>Kocher, Mininder S.</au><au>Lawrence, John T.R.</au><au>Lee, R. Jay</au><au>McKay, Scott D.</au><au>Mistovich, R. Justin</au><au>Patel, Neeraj M.</au><au>Polousky, John D.</au><au>Rhodes, Jason T.</au><au>Sachleben, Brant C.</au><au>Sargent, M. Catherine</au><au>Schmale, Gregory A.</au><au>Shea, Kevin G.</au><au>Yen, Yi-Meng</au><aucorp>Tibial Spine Research Group</aucorp><aucorp>Tibial Spine Research Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model</atitle><jtitle>Orthopaedic journal of sports medicine</jtitle><addtitle>Orthop J Sports Med</addtitle><date>2019-08-01</date><risdate>2019</risdate><volume>7</volume><issue>8</issue><spage>2325967119866162</spage><epage>2325967119866162</epage><pages>2325967119866162-2325967119866162</pages><issn>2325-9671</issn><eissn>2325-9671</eissn><abstract>Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient’s sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon’s decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P &lt; .001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon’s propensity for operative treatment of this fracture was observed (P = .01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent’s preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>31489334</pmid><doi>10.1177/2325967119866162</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2325-9671
ispartof Orthopaedic journal of sports medicine, 2019-08, Vol.7 (8), p.2325967119866162-2325967119866162
issn 2325-9671
2325-9671
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6713965
source DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; SAGE Journals
subjects Decision making
Orthopedics
Pediatrics
Sports medicine
Surgeons
title Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-02T09%3A59%3A43IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Pediatric%20Type%20II%20Tibial%20Spine%20Fractures:%20Addressing%20the%20Treatment%20Controversy%20With%20a%20Mixed-Effects%20Model&rft.jtitle=Orthopaedic%20journal%20of%20sports%20medicine&rft.au=Adams,%20Alexander%20J.&rft.aucorp=Tibial%20Spine%20Research%20Group&rft.date=2019-08-01&rft.volume=7&rft.issue=8&rft.spage=2325967119866162&rft.epage=2325967119866162&rft.pages=2325967119866162-2325967119866162&rft.issn=2325-9671&rft.eissn=2325-9671&rft_id=info:doi/10.1177/2325967119866162&rft_dat=%3Cproquest_pubme%3E2286932154%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2313781652&rft_id=info:pmid/31489334&rft_sage_id=10.1177_2325967119866162&rfr_iscdi=true