Kaloostian Paul E, Kim Jennifer E, Calabresi Peter A, Bydon Ali, Witham Timothy
Department of Neurological Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA. paulkaloostian@ hotmail.com
Orthopedics. 2013 Mar;36(3):e381-3. doi: 10.3928/01477447-20130222-31.
Indoor rock climbing is becoming more popular for people of all ages. Despite the tremendous interest in this competitive sport, participants are made aware of the dangers associated with participating. The authors present the first reported case of a clay-shoveler's fracture at the T1 spinous process during indoor rock climbing. They describe the management and natural history of this fracture and discuss management strategies for this increasingly popular recreational sport.A 14-year-old competitive indoor rock climber presented with acute-onset midline thoracic pain at T1 while indoor rock climbing. He reported no recent falls or trauma but stated that the pain came on abruptly while rock climbing. On examination, he was neurologically intact except for significant tenderness to palpation at the T1 spinous process. Magnetic resonance imaging demonstrated a minimally displaced T1 spinous process fracture with evidence of significant surrounding muscular edema, suggesting an acute fracture. He was treated conservatively with anti-inflammatory drugs, complete climbing restriction, and rest. He continued to have focal upper back pain at the level of the fracture over the next 4 months. He was unable to climb for 4 months until his pain resolved after conservative treatment of climbing restriction, pain control, and rest.This is the first documented case of a clay-shoveler's fracture sustained in a pediatric patient directly attributable to indoor rock climbing.
室内攀岩对各年龄段的人来说都越来越受欢迎。尽管人们对这项竞技运动有着浓厚的兴趣，但参与者也意识到了参与其中所带来的危险。作者报告了首例在室内攀岩过程中发生的T1棘突铲土工骨折病例。他们描述了该骨折的处理方法和自然病程，并讨论了针对这项日益流行的休闲运动的管理策略。一名14岁的室内攀岩竞技者在室内攀岩时出现T1水平的急性中线胸痛。他报告近期没有跌倒或外伤，但称疼痛在攀岩时突然出现。检查时，除了T1棘突有明显压痛外，他的神经功能完好。磁共振成像显示T1棘突骨折有轻微移位，周围有明显的肌肉水肿，提示为急性骨折。他接受了抗炎药物、完全禁止攀岩和休息的保守治疗。在接下来的4个月里，他在骨折部位持续有局部上背部疼痛。在经过禁止攀岩、控制疼痛和休息的保守治疗后疼痛缓解之前，他有4个月无法攀岩。这是首例记录在案的儿科患者因室内攀岩直接导致的铲土工骨折病例。
