Leibner E D, Simanovsky N, Abu-Sneinah K, Nyska M, Porat S
Department of Orthopedic Surgery, Hadassah Medical Center, Jerusalem, Israel.
J Pediatr Orthop B. 2001 Jan;10(1):68-72.
Fractures of the lateral process of the talus are an uncommon injury, which are often misdiagnosed as severe ankle sprain. This error may result in inappropriate treatment of an intraarticular fracture, with subsequent posttraumatic arthrosis. To date, only one fracture of a lateral talar process has been reported in a child, in whom delayed diagnosis and initial mismanagement led to a suboptimal result. The sport of 'snowboarding', which is gaining in popularity, has been significantly associated with fractures of the lateral talar process, leading some authors to dub this fracture 'Snowboarder's Fracture'. This and the ever-increasing incidence of major trauma lead us to believe that this fracture will be encountered more frequently, even in the pediatric population, as the two factors mentioned do not pass over this group. We report lateral talar process fractures in two children: one in a 9-year-old girl and one in an 11-year-old boy, the latter associated with talar neck and body fractures. Timely diagnosis enabled prompt open reduction and internal fixation, preventing subtalar arthrosis. We discuss the pertinent anatomy and mechanism, and present the clinical picture, imaging studies and treatment. Two important points are exemplified by these cases. First, this fracture, although rare, does occur in children, and should be sought in appropriate settings. Second, despite the severe talar injury in the 11 year old, early diagnosis and intervention conserved foot function.
距骨外侧突骨折是一种罕见的损伤，常被误诊为严重的踝关节扭伤。这种误诊可能导致关节内骨折的治疗不当，继而引发创伤后关节炎。迄今为止，仅报道过1例儿童距骨外侧突骨折，其延迟诊断和最初的处理不当导致了欠佳的结果。日益流行的“单板滑雪”运动与距骨外侧突骨折显著相关，这使得一些作者将这种骨折称为“单板滑雪者骨折”。这种骨折以及重大创伤发生率的不断上升使我们相信，即使在儿童群体中，由于上述两个因素不会绕过这一群体，这种骨折将会更频繁地遇到。我们报告了2例儿童距骨外侧突骨折：1例为9岁女孩，另1例为11岁男孩，后者合并距骨颈和体部骨折。及时诊断使得能够迅速进行切开复位内固定，防止了距下关节关节炎。我们讨论了相关的解剖结构和机制，并展示了临床表现、影像学检查及治疗方法。这些病例例证了两个要点。第一，这种骨折虽然罕见，但确实会发生在儿童中，在适当的情况下应予以排查。第二，尽管11岁患儿的距骨损伤严重，但早期诊断和干预保留了足部功能。
