From the Division of Plastic Surgery, Saint Louis University School of Medicine; and SSM Health Cardinal Glennon Children's Hospital at Saint Louis University.
Plast Reconstr Surg. 2022 Mar 1;149(3):662-669. doi: 10.1097/PRS.0000000000008868.
Salter-Harris type II fractures are the most common pediatric phalangeal fracture. A juxtaepiphyseal fracture is a distinct fracture pattern that, although similar in radiographic appearance, occurs 1 to 2 mm distal to the growth plate. Although subtle, there are important differences in the behavior and management of these fracture types. The purpose of this study was to compare these two fracture patterns in terms of clinical features and treatment.
An institutional review board-approved retrospective chart review was conducted of patients presenting to our tertiary care pediatric hospital. One hundred fifty-eight patients with either Salter-Harris type II or juxtaepiphyseal phalangeal fractures were identified. Primary outcomes analyzed included angulation at initial presentation, stability of reduction if attempted in the emergency department, and need for operative fixation with and without Kirschner wire fixation, with final angulation measurements.
Salter-Harris type II fractures were more common than juxtaepiphyseal fractures (83 percent versus 17 percent, respectively). There was no significant difference between the two fracture types in the patient's age, sex, or mechanism of injury. Juxtaepiphyseal fractures were radiographically more angulated on presentation than Salter-Harris type II fractures (p = 0.02). Juxtaepiphyseal fractures required significantly more operative fixation by closed reduction and percutaneous pinning compared to Salter-Harris type II fractures (42.9 percent versus 10.8 percent, respectively; p = 0.002). There was no difference in final outcomes obtained between the two groups.
Juxtaepiphyseal phalangeal fractures are a distinct entity from Salter-Harris type II fractures. Presenting with significantly more radiographic angulation and clinical instability, juxtaepiphyseal fractures more frequently required operative fixation. Recognizing the differences between these pediatric fracture types is important to help guide clinical management for successful healing.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
Salter-Harris Ⅱ型骨折是最常见的儿童指骨骨折。骺板下骨折是一种明显的骨折类型，虽然在影像学上相似，但发生在骺板下 1 至 2 毫米处。尽管细微，但这两种骨折类型在行为和处理上有重要区别。本研究旨在比较这两种骨折类型的临床特征和治疗方法。
对我院三级儿童医院就诊的患者进行机构审查委员会批准的回顾性图表审查。确定了 158 例 Salter-Harris Ⅱ型或骺板下指骨骨折患者。分析的主要结果包括初始表现时的成角、在急诊科尝试复位的稳定性以及是否需要手术固定，包括最终的成角测量。
Salter-Harris Ⅱ型骨折比骺板下骨折更常见（分别为 83%和 17%）。两种骨折类型在患者年龄、性别或损伤机制方面无显著差异。骺板下骨折在影像学上比 Salter-Harris Ⅱ型骨折更成角（p=0.02）。骺板下骨折比 Salter-Harris Ⅱ型骨折更需要通过闭合复位和经皮钢针固定进行手术固定（分别为 42.9%和 10.8%；p=0.002）。两组的最终结果无差异。
骺板下指骨骨折与 Salter-Harris Ⅱ型骨折是不同的实体。骺板下骨折在影像学上和临床上更不稳定，表现为明显更多的成角，更频繁地需要手术固定。认识到这些小儿骨折类型的区别有助于指导临床管理以实现成功愈合。
临床问题/证据水平：风险，Ⅱ。
