Goodell Parker B, Bauer Andrea
UC Davis School of Medicine, 2101A Education Building, 4610 X Street, Sacramento, CA 95817.
Boston Children's Hospital, HUN 213, 300 Longwood Avenue, Boston, MA 02115.
JBJS Rev. 2016 May 3;4(5). doi: 10.2106/JBJS.RVW.O.00028.
Seymour fractures are open juxta-physeal fractures of the distal phalanx. A true lateral radiograph should be obtained for diagnosis, and treatment should include removal of the nail, irrigation and debridement of the fracture, and percutaneous Kirschner wire stabilization. Mallet fractures are more common in children than adults, and treatment is generally nonoperative for nondisplaced or minimally displaced fractures without volar subluxation of the distal phalanx; however, splinting compliance should be carefully assessed in younger populations. Phalangeal neck fractures have a limited potential to remodel and a propensity to redisplace. A true lateral radiograph will show displacement best; treatment is generally with percutaneous pinning. Open reduction should be avoided when possible because of the risk of osteonecrosis of the phalangeal condyles. The epidemiology of scaphoid fractures in children is changing, with waist fractures now the most common type. This may be due to an increase in body mass index (BMI) as well as high-level sports participation in today's pediatric population. Although the vast majority of acute scaphoid fractures can be treated successfully with cast immobilization, children who present with established nonunions should be offered open reduction and internal fixation as the primary treatment.
西摩骨折是指末节指骨的开放性近骨骺骨折。诊断时应拍摄真正的侧位X线片，治疗应包括拔除指甲、冲洗和清创骨折部位以及经皮克氏针固定。锤状指骨折在儿童中比成人更常见，对于无移位或轻度移位且末节指骨无掌侧半脱位的骨折，一般采用非手术治疗；然而，对于较年幼的人群，应仔细评估夹板固定的依从性。指骨颈骨折的重塑潜力有限且有再次移位的倾向。真正的侧位X线片能最好地显示移位情况；一般采用经皮穿针治疗。由于存在指骨髁骨坏死的风险，应尽可能避免切开复位。儿童舟骨骨折的流行病学正在发生变化，目前腰部骨折是最常见的类型。这可能是由于当今儿童群体中体重指数（BMI）的增加以及高水平体育活动的参与。尽管绝大多数急性舟骨骨折通过石膏固定可以成功治疗，但对于已确诊为骨不连的儿童，应首选切开复位内固定作为主要治疗方法。
