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Article Title

Trampoline Associated Non-Contact Fracturesof the Proximal Tibial Metaphysis in Children:A Systematic Review

Abstract

Background: Pediatric injuries of the proximal tibial metaphysis associated with trampoline use are concerning, as they have been reported to spontaneously progress into valgus deformity. The aim of this study was to perform a systematic review of outcomes following fractures of the proximal tibial metaphysis that occur as the result of jumping, particularly on trampolines or inflatable structures, and to assess the incidence of progression to valgus deformity of the proximal tibia. It is hypothesized that this specific mechanism of injury does not result in any future deformity of the tibia. Methods: A duplicate, independent, and systematic search of Embase, MEDLINE, and Web of Science databases was conducted according to Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Seven studies met inclusion criteria, which totaled 87 patients with an age range of 2.0 years to 6.0 years, and a follow-up period ranging from 7.7 months to 36 months. In all studies, fractures occurred while bouncing with other individuals. Fractures were transverse and non-displaced in 71.0% to 100.0% and 86.0% to 100.0% of patients, respectively. Tubercle notch scooping and anterior tilting of the proximal tibial epiphyseal plate were common radiographic findings, observed in 49.0% to 100.0% of patients. No initial coronal deformity was reported. All patients were treated with above-knee cast immobilization with satisfactory fracture healing. No patients went on to develop leg-length discrepancy or tibial deformity in coronal or sagittal planes at final follow-up. Conclusions: Trampoline fractures most commonly occur in patients 2 years to 6 years of age, and are typically the result of two or more individuals using a trampoline simultaneously. Fractures are transverse, non-displaced, without medial gapping and can be identified by tubercle notch scooping and/or anterior tilting of the epiphyseal plate. Diagnosis can be made without the need for advanced imaging techniques. There has been no documented case of progression into valgus deformity or leg-length discrepancy in patients with characteristic trampoline fractures.

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