Beume Jan-Sebastian, Schmittenbecher Peter P
Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
Unfallchirurgie (Heidelb). 2022 Jun;125(6):479-491. doi: 10.1007/s00113-022-01184-x. Epub 2022 May 6.
Shaft fractures of the lower extremities are rare during adolescence. Conservative treatment is no longer used for the upper leg and the significance is declining for the lower leg, as only minor axis deviations and malrotations of the shaft are acceptable and conservative therapy is associated with severe impairments in the daily routine; however, conservative treatment is still an option for femoral fractures in children < 3 years of age and for stable fractures of the lower leg. Various osteosynthesis procedures can be used depending on the body weight and epiphyseal maturation. Elastic stable intramedullary nailing is the first choice, followed by solid adolescent femoral or tibial nailing for higher body weights and external fixation for open or multifragmentary fractures. Plate osteosynthesis is an established alternative. Following correct surgical treatment, all fractures have movement and at least partial load-bearing stability and the results are satisfactory. Regular controls are recommended up to the end of the growth period.
青少年下肢骨干骨折较为罕见。目前大腿不再采用保守治疗,小腿采用保守治疗的意义也在下降,因为只有轻微的骨干轴线偏差和旋转不良是可以接受的,而且保守治疗会导致日常生活严重受限;不过,对于3岁以下儿童的股骨骨折以及小腿稳定骨折,保守治疗仍是一种选择。根据体重和骨骺成熟度可采用多种接骨术。弹性稳定髓内钉固定是首选,对于体重较大者,其次可采用坚固的青少年股骨或胫骨髓内钉固定,开放性或多段骨折则采用外固定。钢板接骨术是一种既定的替代方法。经过正确的手术治疗后,所有骨折都能活动且至少具有部分负重稳定性,结果令人满意。建议在生长期末期前定期进行检查。