Department of Orthopedics and Traumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Department of Orthopedic Surgery, Polyclinique Bordeaux Nord Aquitaine, 33 Rue du Dr Finlay, 33300 Bordeaux, France.
Foot Ankle Surg. 2022 Apr;28(3):294-299. doi: 10.1016/j.fas.2021.04.010. Epub 2021 May 1.
Ankle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions.
A systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis.
SH1 fractures were found in 0-57.5% of the cases in all series and 0-3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2-80% and an osteochondral avulsion of the distal fibula in 6-28.1%. The most recent series report 76-80% and 62% for ATFL injury and osteochondral avulsion respectively.
There is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities.
儿童和青少年踝关节创伤是小儿创伤中最常见的骨科损伤。长期以来，人们一直认为该人群的外侧踝关节损伤通常是腓骨远端的 Salter 和 Harris Ⅰ型骨折（SH1）。本研究的目的是确认外侧踝关节扭伤的存在，并报告外侧踝关节间隙的每种病理的发生率：SH1 骨折、ATFL 损伤和骨软骨撕脱。
使用 PubMed 和 Embase 提供的数据库进行系统文献回顾。所有报告儿童和青少年影像学证实的外侧踝关节损伤（SH1、ATFL 损伤、骨软骨撕脱）发生率的文章均被纳入。排除标准为：病例报告或少于 10 例的文章、未指定影像学方式和与外侧踝关节病变无关的文章。因此，共筛选出 237 个标题和摘要，其中 25 个进行了深入分析，最终有 11 篇文章纳入分析。
所有系列中 SH1 骨折的发生率为 0-57.5%，最近系列中为 0-3%。3.2-80%的病例诊断为 ATFL 损伤，6-28.1%的病例诊断为腓骨远端骨软骨撕脱。最近的系列报告分别为 76-80%和 62%的 ATFL 损伤和骨软骨撕脱。
在疑似 SH1 腓骨远端骨折的患者中，ATFL 扭伤和腓骨末端撕脱的发生率相当高。根据最近的证据和 MRI 检查，儿童踝关节最常见的损伤是 ATFL 扭伤和骨软骨撕脱。在日常实践中，这应该在进行影像学检查和决定治疗方式时加以考虑。
