Voizard Philippe, Moore James, Leduc Stéphane, Nault Marie-Lyne
CHU Sainte-Justine, Chemin de la Côte Ste-Catherine Université de Montréal, Department of Surgery, Boul. Edouard-Montpetit, Montreal, Quebec Hôpital du Sacré-Cœur de Montréal, Boul. Gouin oust, Montreal, QC, Canada.
Medicine (Baltimore). 2018 Jun;97(24):e11020. doi: 10.1097/MD.0000000000011020.
Frequent misdiagnosis of pediatric ankle traumas leads to inappropriate management, which may result in residual pain, instability, slower return to physical activity, and long-term degenerative changes. The purpose of this study was to evaluate the consistency of diagnosis, management, and the treatment of acute lateral pediatric ankle trauma in a tertiary care pediatric hospital. The hypothesis was that the initial diagnosis is often incorrect, and the treatment varies considerably amongst orthopedic surgeons.We conducted a retrospective study of all cases of ankle sprains and Salter-Harris one (SH1) fractures referred to our orthopedic surgery service between May and August 2014. Exclusion criteria included ankle fractures other than SH1 types, and cases where treatment was initially undertaken elsewhere before referral to our service. Primary outcome was the difference between initial and final diagnosis.Among 3047 cases reviewed, 31 matched our inclusion criteria. Initial diagnosis was 20 SH1 fractures, 8 acute ankle sprains, and 3 uncertain, with a change in diagnosis for 48.5% at follow-up.Accurate diagnosis can be difficult in pediatric ankle trauma, with case management and specific treatments varying considerably. This study reinforces the need to evaluate the safety of a general treatment algorithm for all lateral ankle trauma with normal radiographs.Level of evidence III.
小儿踝关节创伤的频繁误诊会导致治疗不当，进而可能引发残留疼痛、关节不稳、恢复体育活动的时间延长以及长期的退行性改变。本研究的目的是评估一家三级儿科医院对小儿急性外侧踝关节创伤的诊断、处理及治疗的一致性。研究假设为初始诊断常常有误，且骨科医生之间的治疗差异很大。我们对2014年5月至8月间转诊至我院骨科的所有踝关节扭伤及Salter-Harris I型（SH1）骨折病例进行了一项回顾性研究。排除标准包括非SH1型的踝关节骨折，以及在转诊至我院之前已在其他地方接受过初始治疗的病例。主要结局指标为初始诊断与最终诊断之间的差异。在3047例回顾病例中，有31例符合纳入标准。初始诊断为20例SH1骨折、8例急性踝关节扭伤、3例诊断不明确，随访时诊断改变率为48.5%。小儿踝关节创伤的准确诊断可能存在困难，病例处理及具体治疗差异很大。本研究强化了评估针对所有X线片正常的外侧踝关节创伤的通用治疗方案安全性的必要性。证据级别为III级。
