Harris Taylor A, Krumrey Jacqueline, Sharp Jennifer
Orthopedics, Good Samaritan Regional Medical Center, Corvallis, USA.
Orthopedics and Traumatology, Good Samaritan Regional Medical Center, Corvallis, USA.
Cureus. 2021 Aug 17;13(8):e17246. doi: 10.7759/cureus.17246. eCollection 2021 Aug.
While toe fractures are the most common fractures of the foot in the pediatric population, the majority of these injuries do not require aggressive treatment. However, the mechanism of stubbing the great toe with bleeding at the base of the nail, a laceration proximal to the nail fold, or signs of a displaced fracture through the physis of the distal phalanx signal a likely open fracture involving the distal phalanx of the great toe. Unrecognized open fractures can lead to mistreatment and consequently osteomyelitis or growth disturbances. We report a case of a patient who required open reduction and Kirschner wire (K-wire) stabilization of a Salter-Harris I fracture involving the distal phalanx of the great toe after delayed recognition of the initial injury and subsequent failure to obtain closed reduction with a digital block in the clinic setting. We present this case to demonstrate the importance of vigilance in the evaluation of stubbed great toe injuries and propose an algorithm to guide the management of these injuries.
虽然趾骨骨折是儿科人群中最常见的足部骨折，但大多数此类损伤不需要积极治疗。然而，大脚趾踢到东西后在指甲根部出血、甲襞近端撕裂，或通过远端指骨骨骺出现移位骨折的迹象，提示可能存在涉及大脚趾远端指骨的开放性骨折。未被识别的开放性骨折可能导致治疗不当，进而引发骨髓炎或生长障碍。我们报告一例患者，其在最初受伤后延迟诊断，随后在门诊环境中进行指神经阻滞未能成功闭合复位，最终需要对涉及大脚趾远端指骨的Salter-Harris I型骨折进行切开复位和克氏针固定。我们展示此病例以证明在评估大脚趾踢伤时保持警惕的重要性，并提出一种算法来指导这些损伤的处理。
