{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:19:42Z","timestamp":1791544782850,"version":"4.3.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The uncommon nature of tibial spine fractures (TSFs) may result in delayed diagnosis and treatment. The outcomes of delayed surgery are unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate risk factors for, and outcomes of, delayed surgical treatment of pediatric TSFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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 \u226521 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 368 patients (mean age, 11.7 \u00b1 2.9 years) were included, 21.2% of whom underwent surgery \u226521 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF at \u22651 weeks after injury (95% CI, 1.1-14.3;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04), 2.1 times higher odds of having seen multiple clinicians before the treating surgeon (95% CI, 1.1-4.1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03), 5.8 times higher odds of having magnetic resonance imaging (MRI) \u22651 weeks after injury (95% CI, 1.6-20.8;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .007), and were 2.2 times more likely to have public insurance (95% CI, 1.3-3.9;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005). Meniscal injuries were encountered intraoperatively in 42.3% of patients with delayed surgery versus 21.0% of patients treated without delay (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), resulting in 2.8 times higher odds in multivariate analysis (95% CI, 1.6-5.0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Delayed surgery was also a risk factor for procedure duration &gt;2.5 hours (odds ratio, 3.3; 95% CI, 1.4-7.9;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .006). Patients who experienced delayed surgery and also had an operation &gt;2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI, 1.1-12.5;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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 &gt;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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671221078333","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T11:13:10Z","timestamp":1646651590000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["What Are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures? A Multicenter Study"],"prefix":"10.1177","volume":"10","author":[{"given":"Haley E.","family":"Smith","sequence":"first","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Aristides I.","family":"Cruz","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Justin","family":"Mistovich","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasina M.","family":"Leska","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore J.","family":"Ganley","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien T.","family":"Aoyama","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry B.","family":"Ellis","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indranil","family":"Kushare","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rushyuan J.","family":"Lee","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"McKay","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd A.","family":"Milbrandt","sequence":"additional","affiliation":[{"name":"All authors are listed in the Authors section at the end of this article."},{"name":"Investigation performed at Ann &amp; Robert H. 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