Pfeifle Viktoria Amanda, Schreiner Simone, Trachsel Daniel, Holland-Cunz Stefan Gerhard, Mayr Johannes
University Children's Hospital Basel (UKBB), Department of Pediatric Surgery, 4056 Basel.
University Children's Hospital Basel (UKBB); Department of Pediatric Orthopedics, 4056 Basel.
Medicine (Baltimore). 2019 Apr;98(16):e15294. doi: 10.1097/MD.0000000000015294.
Damage control is a staged surgical approach to manage polytraumatized patients. The damage control approach comprises three steps. First, bleeding is controlled and fractures are stabilized temporarily; second, vital parameters are stabilized and the child is rewarmed in the intensive care unit; and third, the child is reoperated for definitive repair of injuries. We aimed to describe the feasibility of the damage control orthopedic approach in a child.
An 8-year-old girl fell from the balcony of the 5th floor onto concrete pavement and was admitted to our accident and emergency ward in a stable cardiorespiratory state, but with gross deformity of the lower limbs, left thigh, and forearm.
The child had sustained multiple injuries with severe bilateral lung contusion, pneumothorax, fracture of first rib, liver laceration, stable spine fractures, transforaminal fracture of sacrum, pelvic ring fracture, displaced baso-cervical femoral neck fracture, displaced bilateral multifragmental growth plate fractures of both tibiae, fractures of both fibulae, displaced fracture of left forearm, and displaced supracondylar fracture of the humerus.
In the initial operation, we performed closed reduction and K-wire fixation of the right tibia, closed reduction and external fixation of the left tibia, open reduction and screw osteosynthesis of the femoral neck fracture, closed reduction and K-wire fixation of the radius, and closed reduction of the supracondylar fracture. Subsequently, we transferred the girl to the pediatric intensive care unit for hemodynamic stabilization, respiratory therapy, rewarming, and treatment of crush syndrome. In a third step, 10 days after the injury, we managed the supracondylar fracture of the humerus by closed reduction and K-wire fixation.
Growth arrest of the left distal tibial growth plate and osteonecrosis of the femoral head and neck, slipped capital femoris epiphysis (SCFE), and coxa vara of the right femur led to balanced leg length inequality 2 years after the injury. The lesion of the left sciatic nerve improved over time and the girl walked without walking aids and took part in school sports but avoided jumping exercises.
We emphasize the importance of damage control principles when managing polytraumatized children.
损伤控制是一种用于治疗多发伤患者的分阶段手术方法。损伤控制方法包括三个步骤。首先，控制出血并临时固定骨折；其次，稳定生命体征参数，并在重症监护病房对患儿进行复温；第三，对患儿进行再次手术以进行损伤的确定性修复。我们旨在描述损伤控制骨科方法在儿童中的可行性。
一名8岁女孩从5楼阳台坠落到水泥路面，被送入我院急诊病房，心肺状态稳定，但下肢、左大腿和前臂严重畸形。
该患儿多处受伤，包括严重双侧肺挫伤、气胸、第一肋骨骨折、肝裂伤、稳定型脊柱骨折、骶骨经椎间孔骨折、骨盆环骨折、基底-颈型股骨颈移位骨折、双侧胫骨多发移位生长板骨折、双侧腓骨骨折、左前臂移位骨折以及肱骨髁上移位骨折。
在初次手术中，我们对右胫骨进行了闭合复位和克氏针固定，对左胫骨进行了闭合复位和外固定，对股骨颈骨折进行了切开复位和螺钉内固定，对桡骨进行了闭合复位和克氏针固定，以及对髁上骨折进行了闭合复位。随后，我们将女孩转入儿科重症监护病房进行血流动力学稳定、呼吸治疗、复温以及挤压综合征的治疗。第三步，在受伤10天后，我们通过闭合复位和克氏针固定处理了肱骨髁上骨折。
受伤2年后，左胫骨远端生长板生长停滞、股骨头和颈部骨坏死、股骨头骨骺滑脱（SCFE）以及右股骨髋内翻导致双下肢长度平衡不等。左侧坐骨神经损伤随时间改善，女孩无需辅助行走并参加学校体育活动，但避免跳跃运动。
我们强调在治疗多发伤儿童时损伤控制原则的重要性。
