Abzug Joshua M, Dua Karan, Sesko Bauer Andrea, Cornwall Roger, Wyrick Theresa O
Associate Professor, Departments of Orthopedics and Pediatrics, University of Maryland School of Medicine, Director, University of Maryland Brachial Plexus Clinic, Director of Pediatric Orthopedics, University of Maryland Medical Center, Deputy Surgeon-in-Chief, University of Maryland Children's Hospital, Baltimore, Maryland.
Instr Course Lect. 2017 Feb 15;66:417-427.
Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits in the United States for fractures. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which make fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.
指骨骨折是儿科人群中最常见的手部骨折类型，在美国因骨折而到急诊科就诊的人数中占第二高。指骨骨折的发病率在10至14岁的儿童中最高，这与大多数儿童开始进行接触性运动的时间相吻合。年龄较小的儿童由于挤压伤和撕裂伤，更有可能在家中发生指骨骨折。近端指骨的Salter-Harris II型骨折是最常见的手指骨折类型。与周围的韧带结构和成熟骨骼相比，未矿化的骨骺在生物力学上较弱，这使得骨骺周围的骨折很可能发生。必须进行全面的体格检查，以评估手指排列情况，寻找旋转畸形和/或冠状面畸形的迹象。手部和手指的X线平片足以确诊指骨骨折。指骨骨折的治疗基于损伤的初始严重程度，并取决于闭合复位技术的成功与否。无移位的指骨骨折采用夹板固定治疗。稳定的、已复位的指骨骨折需要固定，但需要密切监测以确保骨折复位得以维持。不稳定的、移位的指骨骨折需要手术治疗，最好是通过闭合复位和经皮穿针固定。
