Pai Sunil Kumar, Aslam Pervez Nayef, Radcliffe Graham
The Department of Orthopaedics, Bradford Royal Infirmary, Duckworth Lane, Bradford, West Yorkshire BD9 6RJ, UK.
Case Rep Med. 2012;2012:506798. doi: 10.1155/2012/506798. Epub 2012 May 20.
Although tibial end avulsions of the anterior cruciate ligament are relatively common in clinical practice, avulsions of the femoral end of this ligament are by comparison rare. We present the case of an 11-year-old boy with a bony avulsion injury, which was presumed to have arisen from the tibial insertion of the anterior cruciate ligament but turned out instead to be an osteochondral avulsion fracture of the femoral origin. This unexpected finding that was not detected during preoperative workup resulted in the first attempt at surgical fixation being aborted. The need for a second planned definitive fixation procedure emphasises the importance of combining a thorough history and examination in association with appropriate imaging in the patient workup. The patient's definitive operative treatment and outcome are described. Although rare, surgeons (and emergency room doctors) treating such patients should include femoral end avulsion injuries of the anterior cruciate ligament in the differential diagnosis of a child presenting with an acute haemarthrosis of the knee. Furthermore, once diagnosed, early onward referral to an experienced knee surgeon is advocated.
虽然在临床实践中，前交叉韧带胫骨端撕脱相对常见，但相比之下，该韧带股骨端的撕脱则较为罕见。我们报告了一例11岁男孩的骨撕脱伤病例，最初推测该损伤源于前交叉韧带的胫骨附着点，但结果却是股骨起源的骨软骨撕脱骨折。这一在术前检查中未被发现的意外发现导致首次手术固定尝试中止。第二次计划性确定性固定手术的必要性强调了在患者检查过程中，将详尽的病史和体格检查与适当的影像学检查相结合的重要性。本文描述了该患者的确定性手术治疗及结果。尽管罕见，但治疗此类患者的外科医生（以及急诊医生）在鉴别诊断出现急性膝关节积血的儿童时，应将前交叉韧带股骨端撕脱伤纳入考虑。此外，一旦确诊，提倡尽早转诊至经验丰富的膝关节外科医生处。
