Opara Nnennaya U, Osuala Emmanuella C, Nwagbara Ugochinyere I
Department of Emergency Medicine, Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV 25304, USA.
Department of Health Administration, University of Phoenix, Phoenix, AZ 85040, USA.
Medicines (Basel). 2022 Sep 22;9(10):50. doi: 10.3390/medicines9100050.
Salter-Harris fractures may occur due to a single injury or repetitive stress fractures on the extremities. Type I to III fractures are managed medically, while types IV and V, which are rare, are treated surgically. In the pediatric population, Salter-Harris I fractures of the distal tibia are commonly seen, and management of such fractures are well established in the literature. Despite the availability of a wide range of treatment for such fractures, osteonecrosis or avascular necrosis of the proximal femur can subsequently develop. Avascular necrosis is cell death secondary to metabolic disturbances, trauma, adverse effects of certain medications, or sickle cell disease. Avascular necrosis commonly affects the talus, humerus, or tibia in addition to the femoral head. Radiographic images are essential for prompt diagnosis and to minimize negative health outcomes in these patients. However, Salter-Harris I fracture in sickle cell patients can be very challenging due to these patients' vulnerability to bone infections and sickle cell crisis. In this case report, our patient with a history of sickle cell disease and with a diagnosis of Salter-Harris I fracture was treated with surgical intervention as type V, which is discussed in this article, and responded well to treatment. Thus, this case suggests a new approach to managing Salter-Harris I fractures complicated with osteomyelitis in sickle cell patients.
Salter-Harris骨折可能由于四肢的单次损伤或重复性应力性骨折而发生。I至III型骨折采用保守治疗，而罕见的IV型和V型骨折则需手术治疗。在儿科人群中，胫骨远端的Salter-Harris I型骨折较为常见，此类骨折的治疗方法在文献中已有充分记载。尽管针对此类骨折有多种治疗方法，但随后仍可能发生股骨头缺血性坏死或无菌性坏死。缺血性坏死是继发于代谢紊乱、创伤、某些药物的不良反应或镰状细胞病的细胞死亡。除股骨头外，缺血性坏死通常还会影响距骨、肱骨或胫骨。影像学检查对于这些患者的及时诊断和将负面健康后果降至最低至关重要。然而，镰状细胞病患者的Salter-Harris I型骨折极具挑战性，因为这些患者易发生骨感染和镰状细胞危象。在本病例报告中，我们的患者有镰状细胞病病史，诊断为Salter-Harris I型骨折，按V型进行了手术干预治疗，本文对此进行了讨论，患者对治疗反应良好。因此，本病例提示了一种治疗镰状细胞病患者合并骨髓炎的Salter-Harris I型骨折的新方法。
