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小儿踝关节骨折:在多样化背景下通过综合诊断与保守治疗实现成功塑形与恢复

Pediatric Ankle Fractures: Successful Remodeling and Restoration Through Comprehensive Diagnosis and Conservative Management in a Diverse Context.

作者信息

Pechlivanidou Evmorfia, Constantas Orestis, Kallaras Evangelos, Chatzikyriakos Alexandros, Margariti Rodanthi, Sekouris Nikolaos, Zogakis Panteleimon N

机构信息

1st Department of Orthopedics, P. & A. Kyriakou Children's Hospital, Athens, GRC.

Department of Hygiene, Epidemiology, and Medical Statistics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC.

出版信息

Cureus. 2024 Feb 4;16(2):e53547. doi: 10.7759/cureus.53547. eCollection 2024 Feb.

DOI:10.7759/cureus.53547
PMID:38445114
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10913128/
Abstract

Diagnosing toddler ankle fractures, especially those that affect several bones, can be difficult. The infrequency of such complex injuries, particularly in household environments, emphasizes the importance of increased awareness in diagnosing and managing these types of injuries. We present a compelling case study of a 20-month-old toddler of a low socioeconomic background who sustained fractures in the ankle, calcaneus, tibia, and fibula after being trapped under furniture. The diagnostic process involved trauma guidelines, radiographic assessments, and axial CT scans. Conservative management, including an eight-week plaster cast, was chosen based on the careful consideration of the child's age, the nature of the fracture, and the absence of immediate surgical indications. The follow-up period involved radiographic assessments, as well as repeated regular clinical examinations, revealing consistent alignment and the absence of complications. The successful outcome underscores the importance of a comprehensive diagnostic approach, thoughtful treatment planning, and meticulous follow-up. Individualized care, considering both clinical and socioeconomic factors, proved crucial for optimal outcomes in pediatric orthopedics. The case contributes valuable insights into the evolving landscape of early childhood orthopedics, emphasizing the need for a discerning approach to diagnosing and managing complex fractures in this population. Conservative treatment could significantly assist when absolute surgical indications are lacking both in cases of minimal resources where multiple operations are not plausible and when the patient's social history raises awareness.

摘要

诊断幼儿踝关节骨折,尤其是那些涉及多块骨头的骨折,可能具有挑战性。此类复杂损伤并不常见,特别是在家庭环境中,这凸显了提高对这类损伤诊断和处理意识的重要性。我们展示了一个引人关注的案例研究,对象是一名20个月大、社会经济背景较差的幼儿,其在被困于家具之下后,踝关节、跟骨、胫骨和腓骨均发生骨折。诊断过程包括遵循创伤指南、进行影像学评估以及轴向CT扫描。基于对患儿年龄、骨折性质以及不存在立即手术指征的仔细考量,选择了保守治疗方案,包括为期八周的石膏固定。随访期间进行了影像学评估以及多次定期临床检查,结果显示骨折对位良好且无并发症。这一成功结果强调了全面诊断方法、周全治疗计划以及细致随访的重要性。考虑临床和社会经济因素的个体化护理,对于小儿骨科实现最佳治疗效果被证明至关重要。该案例为幼儿骨科领域的发展提供了宝贵见解,强调了在这一人群中对复杂骨折进行诊断和处理时需要有敏锐的方法。当缺乏绝对手术指征时,无论是在资源有限无法进行多次手术的情况下,还是当患者的社会背景引发关注时,保守治疗都能提供显著帮助。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2da3/10913128/594a16522466/cureus-0016-00000053547-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2da3/10913128/3db1954c3a74/cureus-0016-00000053547-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2da3/10913128/594a16522466/cureus-0016-00000053547-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2da3/10913128/3db1954c3a74/cureus-0016-00000053547-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2da3/10913128/594a16522466/cureus-0016-00000053547-i02.jpg

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本文引用的文献

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Pediatric ankle and foot injuries: identification and management in the emergency department.儿科踝关节和足部损伤:急诊科的识别和处理。
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Randomized controlled trial of multidisciplinary rehabilitation therapy using mobile applications in cases of ankle fractures.踝关节骨折病例中使用移动应用程序的多学科康复治疗随机对照试验
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Impact of the COVID-19 lockdown on the epidemiologic and clinic profiles of domestic accidents in children.
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Ankle fractures in children.儿童踝关节骨折
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Conservative Treatment or Surgical Treatment: A Case Report and Literature Review of Multiple Fractures of the Lower Extremities in a Child with Insensitivity to Pain.保守治疗还是手术治疗:一例疼痛不敏感儿童下肢多发骨折的病例报告及文献综述
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Management of ankle fractures in children.儿童踝关节骨折的治疗
Br J Hosp Med (Lond). 2019 Apr 2;80(4):201-203. doi: 10.12968/hmed.2019.80.4.201.
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