Patwardhan Sandeep, Omkaram Sujith
Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, 16 Shivajinagar, Pune, 411005 India.
Indian J Orthop. 2021 Mar 8;55(3):539-548. doi: 10.1007/s43465-020-00333-x. eCollection 2021 Jun.
TRASH lesions are a group of special injuries around the elbow resulting from high energy trauma that are routinely missed at initial presentation because of seemingly normal X-rays. These are a group of osteochondral injuries having a high propensity for surgical intervention and usually have poor outcomes if not treated adequately. Prompt diagnosis warrants a high index of suspicion even when a radiograph appears to be normal with a disproportionately swollen elbow in a child. TRASH lesions include radial head osteochondral fractures, medial condylar fractures in unossified elbow, transphyseal separations of the distal humerus, monteggia lesions, entrapped incarcerated medial epicondylar fractures, capitellar shear fractures, lateral condylar fractures extending to the cartilage. This article attempts to review in brief, the approach to early diagnosis and management with literature review and case examples.
TRASH损伤是一组因高能量创伤导致的肘部周围特殊损伤,由于初始X线表现看似正常,这些损伤在初次就诊时常常被漏诊。它们是一组骨软骨损伤,手术干预倾向高,如果治疗不充分通常预后较差。即使X线片看似正常,但儿童肘部肿胀程度不成比例时,快速诊断需要高度怀疑。TRASH损伤包括桡骨头骨软骨骨折、未骨化肘部的内侧髁骨折、肱骨远端骨骺分离、孟氏骨折、内侧髁嵌顿骨折、肱骨小头剪切骨折、延伸至软骨的外侧髁骨折。本文试图通过文献综述和病例举例简要回顾早期诊断和治疗方法。