Murphy Robert F, Hedequist Daniel
Boston Children's Hospital, Boston, MA.
Am J Orthop (Belle Mead NJ). 2015 Nov;44(11):515-7.
While clay-shoveler's fractures in athletes are usually treated conservatively with rest, activity modification, and return to activities when symptoms abate, nonunion of these fractures can occur, given the ligamentous attachments and muscular forces acting on the fracture fragment. Surgical treatment for recalcitrant symptomatic nonunions in adolescent athletes has not been described in the literature. We examined the medical records and radiographs of adolescent athletes who presented with persistent symptoms related to a T1 spinous process nonunion at our institution. Three adolescent athletes were identified who underwent surgical excision of a nonunited ossicle after a T1 spinous process fracture and failure of conservative treatment. All patients had complete pain relief and were able to return to sports after surgical excision. There were no surgical complications. Persistent pain after a clay-shoveler's fracture in athletes has been described in the literature. This is the first case series describing surgical excision of the nonunited ossicle in athletes unable to return to play because of persistent disabling pain at the nonunion site. Excision should be considered if patients experience persistent pain after this injury, with expectation of complete resolution of symptoms after surgery.
虽然运动员的铲土者骨折通常采用保守治疗，包括休息、调整活动，待症状减轻后恢复活动，但鉴于骨折碎片上的韧带附着和肌肉力量，这些骨折可能会出现不愈合。青少年运动员顽固性症状性骨折不愈合的手术治疗在文献中尚无描述。我们检查了在我院就诊的有与T1棘突不愈合相关持续症状的青少年运动员的病历和X光片。确定了三名青少年运动员，他们在T1棘突骨折且保守治疗失败后接受了未愈合小骨块的手术切除。所有患者术后疼痛完全缓解，术后能够恢复运动。无手术并发症。文献中曾描述过运动员铲土者骨折后持续疼痛的情况。这是首例描述因骨折不愈合部位持续致残性疼痛而无法恢复运动的运动员进行未愈合小骨块手术切除的病例系列。如果患者受伤后持续疼痛，且预期手术后症状能完全缓解，则应考虑进行切除手术。
