Chew Ee Ming, Chong Alphonsus K S
Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
J Hand Surg Am. 2012 Aug;37(8):1684-8. doi: 10.1016/j.jhsa.2012.05.010. Epub 2012 Jul 3.
To determine the local epidemiology of pediatric hand fractures and the rate of misdiagnosis.
A retrospective study was performed on children aged 17 years and younger who were referred for actual or suspected metacarpal and phalangeal fractures. Medical records were reviewed for age at the time of injury, sex, fracture pattern, venue where the injury was sustained, injury mechanism, and diagnoses made by the referring doctor and hand surgeon. Differing diagnoses were considered misdiagnoses. The misdiagnosis rate was calculated as the percentage of misdiagnoses over the number of referrals.
Of 204 cases reviewed, emergency physicians referred 146 cases (72%), and primary health care physicians referred the rest. There were 193 cases of actual fractures in 181 patients and 16 cases of misdiagnosis. The fracture incidence peaked at 14 and 15 years. The median ages of children sustaining fractures of the distal phalanges, proximal phalanges, and metacarpals were 9, 12, and 15 years, respectively. The proximal phalanx was most commonly fractured (95 cases, 49%), as was the fifth ray (78 cases, 40%). Most fractures occurred at school (79 cases, 44%). Sports-related injury was the leading cause of fractures (70 cases, 39%). The misdiagnosis rate was 8% (16 of 204). The leading cause of misdiagnosis was misinterpretation of epiphyses (6 of 16), followed by missing multiple fractures (3 of 16).
The higher fracture incidence in teenagers is likely related to sports participation. Sports accounted for proximal fractures in older children, whereas young children sustained distal fractures through crushing injuries. Although the misdiagnosis rate seemed low, it might reflect that emergency physicians, who referred most of the cases, were adept at diagnosing fractures. To improve diagnostic accuracy, doctors should familiarize themselves with the location of epiphyses and look carefully for multiple fractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and Decision Analysis IV.
确定小儿手部骨折的当地流行病学情况及误诊率。
对17岁及以下因实际或疑似掌骨和指骨骨折而转诊的儿童进行回顾性研究。查阅病历，了解受伤时的年龄、性别、骨折类型、受伤地点、受伤机制以及转诊医生和手外科医生做出的诊断。不同的诊断被视为误诊。误诊率以误诊数占转诊数的百分比计算。
在204例被审查的病例中，急诊医生转诊了146例（72%），其余由初级卫生保健医生转诊。181名患者中有193例实际骨折，16例误诊。骨折发病率在14岁和15岁时达到峰值。远端指骨、近端指骨和掌骨骨折患儿的中位年龄分别为9岁、12岁和15岁。近端指骨骨折最常见（95例，49%），第五掌骨骨折也最常见（78例，40%）。大多数骨折发生在学校（79例，44%）。与运动相关的损伤是骨折的主要原因（70例，39%）。误诊率为8%（204例中的16例）。误诊的主要原因是骨骺误判（16例中的6例），其次是漏诊多处骨折（16例中的3例）。
青少年骨折发病率较高可能与参与体育运动有关。运动导致大龄儿童近端骨折，而幼儿因挤压伤导致远端骨折。尽管误诊率似乎较低，但这可能反映出转诊大多数病例的急诊医生擅长诊断骨折。为提高诊断准确性，医生应熟悉骨骺位置并仔细查找多处骨折。
研究类型/证据水平：经济与决策分析IV。
