From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic.
Plast Reconstr Surg. 2018 Sep;142(3):720-729. doi: 10.1097/PRS.0000000000004645.
Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated.
A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016.
Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients.
The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
伴有或不伴有甲床裂伤临床证据的远节指骨的 Salter-Harris 骨折经常治疗不足。
对 2004 年至 2016 年间治疗的所有远节指骨 Salter-Harris 骨折患者进行了回顾性分析。
70 例患者共治疗 72 例 Salter-Harris 骨折，平均年龄为 11.3 ± 3.7 岁。中位数随访时间为 6 周（四分位距，4 至 12.6 年）。最常受累的是拇指（n = 21），其次是示指（n = 18）、中指（n = 17）、环指（n = 17）、小指（n = 9）和无名指（n = 7）。运动相关损伤占 39 例（54%）。42 例（58%）至少有一个临床发现提示甲床裂伤（甲下血肿、近节甲板半脱位、甲皱襞近端皮肤裂伤、甲下出血、甲皱襞撕裂和甲床撕脱）。在 42 例至少有一个甲床裂伤特征的骨折中，38 例进行了手术探查。在探查时，31 例（82%）发现甲床裂伤，18 例（47%）发现软组织嵌顿。有甲床裂伤临床特征的骨折（n = 42）采用切开复位和夹板固定（n = 25）、切开复位和经皮克氏针固定（n = 13）或夹板固定（n = 4）治疗。获得了良好的结果，不良结局很少。6 例患者发生感染并发症。
伴有甲床裂伤临床特征的 Salter-Harris 骨折中，甲床裂伤和软组织嵌顿的发生率较高，需要手术探查。
临床问题/证据水平：治疗性，IV 级。
