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儿童及青少年踝关节扭伤:诊断陷阱

Ankle sprain injury in child and adolescent: Diagnostic pitfalls.

作者信息

Zairi Mohamed, Msakni Ahmed, Mohseni Ahmed Amin, Jaber Chaker, Toumia Mohamed Laroussi, Saied Walid, Bouchoucha Sami, Boussetta Rim, Nessib Mohamed Nabil

机构信息

Faculty of Medicine of Tunis, Department of Pediatric Orthopedic Surgery, Bechir Hamza Children's Hospital, Tunis, Tunisia.

Faculty of Medicine of Tunis, Department of Cardiovascular Surgery, Hospital of Pneumo-Phtisiology Abderrahman Mami, Tunis, Tunisia.

出版信息

Ann Med Surg (Lond). 2022 Sep 1;82:104540. doi: 10.1016/j.amsu.2022.104540. eCollection 2022 Oct.

Abstract

INTRODUCTION AND IMPORTANCE

Sprained ankles in children and adolescents are rare. Certain diagnostic pitfalls must arise in the mind of the clinician because many differential diagnoses must be confirmed or refuted urgently. Among them, the infectious osteoarticular pathology including acute hematogenous osteomyelitis of the tibia or distal fibula and septic arthritis of the subtalar joint.The main purpose of this work, through four clinical cases, we will discuss diagnostic pitfalls in the course of ankle trauma in children and adolescents.

CASE PRESENTATION CLINICAL

In this work, we have demonstrated through four cases some diagnostic errors in the context of ankle trauma in children and adolescents. Infectious and malignant tumor pathologies are real diagnostic and therapeutic emergencies. For all these cases, the initial diagnosis was a sprained ankle following a gambling or sports accident.

DISCUSSION

Ankle trauma in children and adolescents is a frequent reason for consultation in emergencies. The fear of the orthopedic surgeon is to miss a serious pathology and wrongly make the simple diagnosis of a sprained ankle. Temperature measurement must be systematic. The clinical examination must be meticulous. The interpretation of the radiograph must be cautious. Acute hematogenous osteomyelitis and malignant tumor pathology should be on the surgeon's mind.

CONCLUSION

We have shown through these four examples that a serious pathology can simulate a sprain. Hence, a careful analysis of clinical, biological and radiological elements is the only guarantee of adequate care.

摘要

引言与重要性

儿童和青少年踝关节扭伤较为罕见。临床医生必须警惕某些诊断陷阱,因为许多鉴别诊断需要紧急确认或排除。其中包括感染性骨关节病变,如胫骨或腓骨远端的急性血源性骨髓炎以及距下关节的化脓性关节炎。本研究的主要目的是通过四个临床病例,探讨儿童和青少年踝关节创伤过程中的诊断陷阱。

病例呈现

在本研究中,我们通过四个病例展示了儿童和青少年踝关节创伤背景下的一些诊断失误。感染性和恶性肿瘤病变是真正的诊断和治疗紧急情况。对于所有这些病例,最初的诊断都是赌博或体育事故后踝关节扭伤。

讨论

儿童和青少年的踝关节创伤是急诊中常见的就诊原因。骨科医生担心漏诊严重病变,而错误地简单诊断为踝关节扭伤。必须系统地测量体温。临床检查必须细致入微。对X光片结果的解读必须谨慎。急性血源性骨髓炎和恶性肿瘤病变应始终牢记在外科医生心中。

结论

我们通过这四个例子表明,严重病变可能模拟扭伤。因此,仔细分析临床、生物学和放射学因素是提供充分治疗的唯一保障。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8898/9577441/6c67d13651d5/gr1.jpg

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