Rickert Kathleen D, Hosseinzadeh Pooya, Edmonds Eric W
Pediatric Orthopedics and Scoliosis Center, Rady Children's Hospital.
Department of Orthopedic Surgery, University of California, San Diego, CA.
J Pediatr Orthop. 2018 Sep;38(8):e434-e439. doi: 10.1097/BPO.0000000000001209.
Skeletal trauma is a primary tenet of pediatric orthopaedics. Many high-quality studies have been published over the last few years with substantial relevance to the clinical practice of pediatric orthopaedic trauma. Because of the volume of literature on the subject, this review excludes upper extremity trauma and focuses on the publications affecting the lower extremity.
An electronic search of the PubMed database was performed utilizing keywords for pediatric lower extremity trauma: pelvic injuries, femur fractures, tibial shaft fractures, femur fractures, ankle fractures, and foot fractures. All 835 papers related to the treatment of pediatric orthopaedic trauma of the lower extremity published from January 1, 2012 to July 31, 2017 were reviewed, yielding 25 papers that were believed to contribute significant findings to the profession.
Of the 25 papers selected for presentation within this review, 8 related to tibial shaft injuries, 6 involved the pelvis, 5 involved femur fractures, 4 related to ankle injuries, 2 involved foot injuries, and 1 regarding trauma and venous thromoembolism. The level of evidence for these studies were either level III or IV.
Higher-grade pediatric pelvic fractures do not correlate with increased severity of splenic or hepatic injuries. Successful union of femur fractures in older children can be obtained by surgeon preferred method of surgical management. Pediatric tibia shaft fractures should be managed conservatively in most cases; however, fractures with >20% of displacement and associated fibula fractures have a 40% risk of requiring delayed surgical stabilization. Vigilance remains the sin qua non regarding identification and appropriate management of compartment syndrome and venous thromboemobolism in children. Many Salter-Harris I distal fibula fractures are now believed to be ligamentous injury and can be treated as such. Calcaneous fractures remain uncommon in pediatrics, but minimally invasive approaches of surgical reduction and fixation may reduce complications in management.
Level IV.
骨骼创伤是小儿骨科的主要内容。在过去几年里，已经发表了许多高质量的研究，这些研究与小儿骨科创伤的临床实践密切相关。由于关于该主题的文献数量众多，本综述排除了上肢创伤，重点关注影响下肢的出版物。
利用小儿下肢创伤的关键词对PubMed数据库进行电子检索：骨盆损伤、股骨骨折、胫骨干骨折、股骨骨折、踝关节骨折和足部骨折。对2012年1月1日至2017年7月31日发表的所有835篇与小儿下肢骨科创伤治疗相关的论文进行了综述，筛选出25篇被认为对该领域有重大研究发现的论文。
在本综述中入选展示的25篇论文中，8篇与胫骨干损伤有关，6篇涉及骨盆，5篇涉及股骨骨折，4篇与踝关节损伤有关，2篇涉及足部损伤，1篇关于创伤与静脉血栓栓塞。这些研究的证据级别为III级或IV级。
较高等级的小儿骨盆骨折与脾或肝损伤严重程度的增加无关。大龄儿童股骨骨折通过外科医生首选的手术管理方法可实现成功愈合。小儿胫骨干骨折在大多数情况下应采用保守治疗；然而，移位超过20%且伴有腓骨骨折的骨折有40%的风险需要延迟手术稳定。对于儿童骨筋膜室综合征和静脉血栓栓塞的识别和适当管理，警惕仍然是必不可少的。现在许多Salter-Harris I型腓骨远端骨折被认为是韧带损伤，可按此进行治疗。跟骨骨折在儿科仍然不常见，但微创外科复位和固定方法可能会减少治疗中的并发症。
IV级。
