Little Rhianna M, Milewski Matthew D
Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06040, USA.
Elite Sports Medicine, Connecticut Children's Medical Center, 399 Farmington Avenue, Farmington, CT, 06032, USA.
Curr Rev Musculoskelet Med. 2016 Dec;9(4):478-486. doi: 10.1007/s12178-016-9370-7.
While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently. A thorough understanding of the pertinent developmental anatomy is critical for correlating the clinical findings with the imaging work-up, and for anticipating the most common and the most serious complications of each fracture. Diagnosis is usually made with appropriate plain radiographs with advanced imaging often used for preoperative planning. In general, fracture pattern and degree of displacement determine the need for surgical intervention and the overall outcome. While a variety of fixation techniques or constructs may be used, because of the importance of restoring physeal and articular anatomy for avoidance of growth disturbance and degenerative joint disease, respectively, achieving anatomic, rigid fixation is of greater importance than with many other fracture locations in the growing skeleton.
虽然有些骨折在成人和儿童中的处理方式可能相似,但骨骺骨折仅见于儿童群体,需要特殊考虑。虽然膝关节周围的骨骺骨折相对少见,但由于青少年参与体育和高能量娱乐活动的增加,其发生率正在上升。股骨远端和胫骨近端骨骺骨折的评估和处理方式相似,但胫骨棘和胫骨结节骨折的处理方式略有不同。深入了解相关的发育解剖结构对于将临床发现与影像学检查结果相关联,以及预测每种骨折最常见和最严重的并发症至关重要。诊断通常通过适当的平片进行,术前规划时通常使用高级影像学检查。一般来说,骨折类型和移位程度决定了是否需要手术干预以及总体预后。虽然可以使用多种固定技术或结构,但由于恢复骨骺和关节解剖结构对于避免生长紊乱和退行性关节疾病分别具有重要意义,因此在生长中的骨骼中,实现解剖学上的坚固固定比在许多其他骨折部位更为重要。