*Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Kyounggi-do, Korea; †Department of Anatomy, Ajou University School of Medicine, Suwon, Kyounggi-do, Korea; ‡Division of Foot and ankle surgery, Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Kyounggi-do, Korea; and §Division of Paediatric Orthopaedics, Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Kyounggi-do, Korea.
J Orthop Trauma. 2013 Nov;27(11):651-5. doi: 10.1097/BOT.0b013e31828e5d39.
This study was conducted to categorize barefoot stubbing injuries to the great toe in children by injury mechanism to differentiate benign stubbing injuries from more complex injuries necessitating surgery.
Prospective clinical series of consecutively treated patients.
Tertiary university hospital setting.
Forty-one children who had sustained an indirect injury to the great toe during barefoot sports activities between January 2001 and December 2009 were included.
Conservative or surgical treatment was done according to clinical and radiological findings.
Information regarding injury mechanism was collected from patients, parents, and coaches using skeletal models and assessed by a pediatric orthopedic surgeon. Mechanisms of injury were identified and grouped as follows: hyperabduction-flexion, hyperflexion, hyperabduction-extension, hyperextension, and hyperextension-adduction.
Hyperabduction-flexion was the most common mechanism (n = 16), in which interphalangeal joint dislocation and skin disruption was noted in most cases. The second most common mechanism was hyperabduction-extension (n = 14) in which avulsion fracture of the lateral volar condyle of the proximal phalanx was noted in most cases. This avulsion fracture had the worst prognosis after conservative care.
Based on these results, we have created a grading system and treatment protocol for indirect hallux sports injuries in children. Avulsion fracture of the lateral condyle of the proximal phalanx, a result of hyperabduction-extension, is a high-risk sign of nonunion and should be aggressively treated, contrary to previous guidelines.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在通过损伤机制对儿童赤脚蹠部损伤进行分类，将良性蹠部损伤与需要手术的更复杂损伤区分开来。
连续治疗患者的前瞻性临床系列。
三级大学医院。
2001 年 1 月至 2009 年 12 月期间，41 名儿童在赤脚运动中发生间接大脚趾损伤。
根据临床和影像学发现进行保守或手术治疗。
使用骨骼模型从患者、父母和教练处收集损伤机制信息，并由小儿矫形外科医生评估。确定损伤机制并分组如下：过度外展-屈曲、过度伸展、过度外展-伸展、过度伸展-内收。
过度外展-屈曲是最常见的机制（n = 16），大多数情况下都有关节间脱位和皮肤破裂。第二常见的机制是过度外展-伸展（n = 14），大多数情况下可见近节指骨外侧跖骨突撕脱骨折。这种撕脱骨折在保守治疗后预后最差。
基于这些结果，我们为儿童间接大脚趾运动损伤创建了分级系统和治疗方案。过度外展-伸展引起的近节指骨外侧突撕脱骨折是非愈合的高风险迹象，应积极治疗，与以往的指南相反。
预后 IV 级。请参阅作者指南，以获取完整的证据水平描述。
