Smith Jeremy T, Curtis Tracy A, Spencer Samantha, Kasser James R, Mahan Susan T
Department of Orthopaedics, Children's Hospital Boston, Boston, MA, USA.
J Pediatr Orthop. 2010 Dec;30(8):779-84. doi: 10.1097/BPO.0b013e3181f73e6e.
Pediatric talus fractures are rare with variable rates of posttraumatic complications reported in the literature. The purpose of this retrospective study was to evaluate posttraumatic complications in children after talus fracture and report injury characteristics.
This study included 29 children with talus fractures sustained between 1999 and 2008 at an average age of 13.5 years (range, 1.2-17.8). Patient records and radiographs were reviewed to determine the mechanism of injury, fracture type, associated injuries, and treatment. Posttraumatic complications assessed were avascular necrosis, arthrosis, nonunion or delayed union, neurapraxia, infection or wound-healing problems, and the need for further unanticipated surgery. Clinical follow-up averaged 24 months (range, 6 mo-5 y).
Twenty-nine children sustained a major fracture of the talar body, neck, or head. Avascular necrosis occurred in 2 patients (7%), arthrosis in 5 (17%), delayed union in 1 (3%), neurapraxia in 2 (7%), infection in 0, and the need for further surgery in 3 (10%). Both high-energy mechanism and fracture displacement corresponded to a greater number of posttraumatic complications. The number and severity of talus fractures increased in older children.
In this case series, posttraumatic complications after pediatric talus fractures occurred more frequently after a high-energy mechanism of injury or a displaced fracture. Talus fractures occurred more commonly and with more severity in older children.
Level IV. Retrospective case series.
儿童距骨骨折较为罕见，文献报道的创伤后并发症发生率各不相同。本回顾性研究的目的是评估儿童距骨骨折后的创伤后并发症，并报告损伤特征。
本研究纳入了1999年至2008年间发生距骨骨折的29名儿童，平均年龄13.5岁（范围1.2 - 17.8岁）。回顾患者记录和X线片以确定损伤机制、骨折类型、相关损伤及治疗情况。评估的创伤后并发症包括缺血性坏死、关节病、骨不连或延迟愈合、神经失用、感染或伤口愈合问题以及是否需要进一步的意外手术。临床随访平均24个月（范围6个月 - 5年）。
29名儿童发生了距骨体、颈部或头部的主要骨折。2例（7%）发生缺血性坏死，5例（17%）发生关节病，1例（3%）发生延迟愈合，2例（7%）发生神经失用，无感染病例，3例（10%）需要进一步手术。高能量损伤机制和骨折移位均与更多的创伤后并发症相关。年龄较大儿童的距骨骨折数量和严重程度增加。
在本病例系列中，儿童距骨骨折后的创伤后并发症在高能量损伤机制或移位骨折后更频繁发生。距骨骨折在年龄较大儿童中更常见且更严重。
IV级。回顾性病例系列。
