Duffy Sean, Gelfer Yael, Trompeter Alex, Clarke Anna, Monsell Fergal
Severn Deanery, Bristol, UK.
St George's Hospital, London, UK.
Eur J Orthop Surg Traumatol. 2021 Jul;31(5):883-892. doi: 10.1007/s00590-021-02933-1. Epub 2021 Apr 11.
This article discusses the incidence, applied anatomy and classification of paediatric femoral fractures based on critical appraisal of the available evidence. The aim is to identify techniques that are relevant to contemporary practice whilst excluding the technical details of individual procedures that are beyond the scope of this review. Injuries of the proximal, diaphyseal and distal segments are considered individually as there are considerations that are specific to each anatomical site. Femoral neck fractures are rare injuries and require prompt anatomical reduction and stable fixation to minimise the potentially devastating consequences of avascular necrosis. Diaphyseal fractures are relatively common, and there is a spectrum of management options that depend on patient age and size. Distal femoral fractures often involve the physis, which contributes up to 70% of femoral length. Growth arrest is common consequence of fractures in this region, resulting in angular and length-related deformity. Long-term surveillance is recommended to identify deformity in evolution and provide an opportunity for early intervention. Deliberate injury should be considered in all fractures, particularly distal femoral physeal injuries and fractures in the non-walking child.
本文基于对现有证据的批判性评估，探讨了小儿股骨骨折的发病率、应用解剖学及分类。目的是确定与当代临床实践相关的技术，同时排除超出本综述范围的个别手术的技术细节。由于每个解剖部位都有特定的考虑因素，因此分别考虑股骨近端、骨干和远端的损伤。股骨颈骨折较为罕见，需要及时进行解剖复位和稳定固定，以尽量减少缺血性坏死可能带来的灾难性后果。股骨干骨折相对常见，治疗方案因患者年龄和体型而异。股骨远端骨折常累及骨骺，骨骺对股骨长度的贡献高达70%。生长停滞是该区域骨折的常见后果，会导致角度和长度相关的畸形。建议进行长期监测，以发现正在发展的畸形并提供早期干预的机会。对于所有骨折，尤其是股骨远端骨骺损伤和不会走路儿童的骨折，都应考虑有故意损伤的可能。
