Schiller Jonathan, DeFroda Steven, Blood Travis
From the Department of Orthopaedics, The Warren Alpert Medical School of Brown University, Providence, RI.
J Am Acad Orthop Surg. 2017 Apr;25(4):251-259. doi: 10.5435/JAAOS-D-15-00328.
Lower extremity avulsion fractures are uncommon in the pediatric population and can be misdiagnosed without proper imaging and/or clinical suspicion for these injuries. The most common locations of avulsion injuries are the ischial tuberosity, anterior superior iliac spine, and anterior inferior iliac spine. Less often, avulsion fractures occur in the tibial tubercle, calcaneus, and greater and lesser trochanters. When treated properly with rest and altered weight bearing, most of these injuries heal without complication. Although surgical intervention is rarely necessary, it has a high degree of success when it is used. However, avulsion injuries are often misdiagnosed as muscle strains or apophysitis and are mistakenly treated with early range of motion. An error in diagnosis and/or management can cause nonunion or further displacement, which may require surgery. Improper identification of these injuries can also lead to nerve irritation, chronic pain, and gait dysfunction. Awareness of these injuries and their natural history is important because healed avulsion fractures may resemble neoplastic bone on radiographs.
下肢撕脱性骨折在儿科人群中并不常见，如果没有进行适当的影像学检查和/或对这些损伤缺乏临床怀疑，可能会被误诊。撕脱伤最常见的部位是坐骨结节、髂前上棘和髂前下棘。较少见的情况是，撕脱性骨折发生在胫骨结节、跟骨以及大转子和小转子。如果通过休息和改变负重方式进行适当治疗，大多数此类损伤可顺利愈合而无并发症。虽然很少需要手术干预，但手术治疗成功率很高。然而，撕脱伤常被误诊为肌肉拉伤或骨突炎，并错误地采用早期活动范围的治疗方法。诊断和/或处理错误可能导致骨不连或进一步移位，这可能需要手术治疗。对这些损伤的错误识别还可能导致神经刺激、慢性疼痛和步态功能障碍。了解这些损伤及其自然病程很重要，因为愈合的撕脱性骨折在X线片上可能类似肿瘤性骨。
