Yadav Rajeev, Kasotya Devender, Goel Akash, Bhatia Nishant, Yadav Vedpal
Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
J Orthop Case Rep. 2021 Jul;11(7):86-89. doi: 10.13107/jocr.2021.v11.i07.2330.
Physeal injuries of proximal tibia are uncommon and constitute only 1% of all physeal injuries. Major vessel injuries are also rare in children and occur in 0.6% trauma cases, out of which, injuries of popliteal artery comprise only 5%. The combination of these is an extremely rare injury pattern but is potentially limb threatening. Most of the cases of physeal injuries of proximal tibia along with popliteal artery compromise, reported in the literature include Salter Harris (SH) type II, III, and IV patterns (type II being most common) with pure type I being extremely rare.
We describe a rare posteriorly displaced pure SH I injury of proximal tibial physis with compromised vascularity of the limb. Immediate closed reduction and stabilization with Kirschner wires (K-wires) restored the vascularity of the limb and the patient went on to have a good functional recovery at the last follow-up of 1 year.
Vascular injuries occurring in SH 1 proximal tibial physeal fractures are often overlooked or missed due to the relatively benign appearance of slip with no sharp fragments to injure major vessels. Close monitoring of neurovascular status and a low threshold for fixation, for example, with K-wires, are important to prevent limb threatening ischemia in these relatively simple appearing injuries.
胫骨近端骨骺损伤并不常见，仅占所有骨骺损伤的1%。儿童大血管损伤也很罕见，在0.6%的创伤病例中发生，其中腘动脉损伤仅占5%。这两者的组合是一种极其罕见的损伤模式，但可能威胁肢体。文献报道的大多数胫骨近端骨骺损伤合并腘动脉损伤的病例包括Salter Harris（SH）II型、III型和IV型（II型最常见），单纯I型极为罕见。
我们描述了一例罕见的胫骨近端骨骺单纯SH I型损伤，伴有肢体血管受损，呈后移位。立即闭合复位并用克氏针（K针）固定，恢复了肢体血管，患者在1年的最后随访中功能恢复良好。
SH I型胫骨近端骨骺骨折发生的血管损伤常因移位相对较轻且无尖锐碎片损伤大血管而被忽视或漏诊。密切监测神经血管状况并降低固定阈值，例如使用K针，对于预防这些看似相对简单的损伤中威胁肢体的缺血很重要。
