Wicks Eric D, White Alex E, Marshall Sh'Rae, Hadley Christopher J, Dodson Christopher C
Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Emerg Med. 2018 Oct;55(4):547-552. doi: 10.1016/j.jemermed.2018.07.009. Epub 2018 Sep 1.
Humerus fractures caused by the throwing motion are extremely rare. They have been reported mostly in recreational adult athletes in their third or later decades of life. A pediatric thrower's fracture is even less common, with few reported cases. The pediatric version of this fracture is located in the proximal to midshaft humerus, distinguishing it from the adult type, which occurs in the middle to distal shaft.
A 12-year-old male pitcher experienced a "snap" in his right arm while throwing a pitch in a baseball game. He presented to the Emergency Department with right arm pain and deformity. He was misdiagnosed with a right glenohumeral dislocation and a reduction maneuver was attempted prior to any radiographic imaging. Upon further review of the imaging and outpatient follow-up, he was found to have a humeral spiral fracture consistent with a "ball-thrower's fracture." The fracture healed with conservative treatment and he returned to unrestricted sports participation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recognition of this fracture is important to avoid unnecessary and potentially harmful treatment of the pediatric patient. A thrower's fracture of the pediatric humerus is rare, but glenohumeral dislocation without direct trauma is even less common and has never been reported as a result of the throwing motion in a pediatric patient. Radiographic imaging is important, and consideration of the thrower's fracture should be in the differential for any patient presenting with acute pain and deformity of the arm resulting from throwing any object.
由投掷动作导致的肱骨骨折极为罕见。大多报道见于30多岁及以上的成年业余运动员。小儿投掷者骨折更为少见，报道的病例寥寥无几。小儿型此类骨折位于肱骨近端至中段，有别于发生在肱骨中段至远端的成人型。
一名12岁男性投手在一场棒球比赛中投球时右臂发出“啪”的一声。他因右臂疼痛和畸形就诊于急诊科。在进行任何影像学检查之前，他被误诊为右肩关节脱位并尝试了复位手法。经进一步影像学检查和门诊随访，发现他患有符合“投球者骨折”的肱骨螺旋骨折。骨折经保守治疗愈合，他恢复了无限制的体育活动。急诊医生为何应了解此情况？：认识到这种骨折对于避免对小儿患者进行不必要且可能有害的治疗很重要。小儿肱骨投掷者骨折很少见，但无直接创伤的肩关节脱位更罕见，且从未有小儿患者因投掷动作导致肩关节脱位的报道。影像学检查很重要，对于任何因投掷任何物体而出现手臂急性疼痛和畸形的患者，都应考虑投掷者骨折并进行鉴别诊断。
