Chasm Rose M, Swencki Sharon A
Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
Emerg Med Clin North Am. 2010 Nov;28(4):907-26. doi: 10.1016/j.emc.2010.06.003.
Many well seasoned emergency physicians often find it challenging to assess and treat pediatric patients regardless of the complaint. Because of anatomic and physiologic differences, pediatric patients experience orthopedic injuries that are both unique and specific to this subset of the population. Emergency physicians must be aware of these nuances to properly diagnose and treat these injuries. An understanding of fractures unique to growing bone, such as buckle/torus and greenstick types, will provoke clinicians to have a keener eye when reviewing pediatric radiographs. The Salter-Harris classification provides a proven, generally accepted stratification of injury to describe and properly disposition pediatric fractures. Emergency physicians must also recognize a distal radial fracture, because it is the most common pediatric fracture, and the many complications of the supracondylar fracture. Nursemaid's elbow and ankle injuries are further common presenting complaints that are discussed. Recognition of child abuse and the work-up of the child presenting with a limp are additional areas that the Emergency physician should feel comfortable evaluating.
许多经验丰富的急诊医生常常发现，无论患儿因何不适前来就诊，对其进行评估和治疗都颇具挑战。由于解剖学和生理学上的差异，儿科患者会遭受一些独特的、该群体特有的骨科损伤。急诊医生必须了解这些细微差别，以便正确诊断和治疗这些损伤。了解生长中的骨骼特有的骨折类型，如青枝骨折和裂缝骨折，会促使临床医生在查看儿科X光片时更加敏锐。Salter-Harris分类法为描述和妥善处理儿科骨折提供了一种经过验证且被广泛接受的损伤分层方法。急诊医生还必须认识到桡骨远端骨折，因为它是最常见的儿科骨折，以及髁上骨折的诸多并发症。保姆肘和踝关节损伤是另外常见的就诊主诉，本文也会对此进行讨论。识别虐待儿童情况以及对跛行患儿的检查是急诊医生应能自如评估的其他领域。
