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Kraft DB, Howard JJ. Treatment of a Lisfranc Injury in a 7-Year-Old Boy: Case Report and Surgical Technique. JBJS Case Connect 2022; 12:01709767-202212000-00014. [PMID: 36282903 DOI: 10.2106/jbjs.cc.22.00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022]
Abstract
CASE This is a case of a 7-year-old boy with a Lisfranc injury identified on weight-bearing films who was treated successfully with closed reduction with a clamp and smooth pin fixation. This patient returned to sports without pain or radiographic signs of arthritis at 1 year. CONCLUSION Lisfranc fractures and ligamentous injuries are rare and can occur in skeletally immature children. They have high potential for long-term disability if not properly diagnosed and treated. Although there is no consensus on optimal management of pediatric Lisfranc injuries, restoration of an anatomic Lisfranc joint with smooth pins and immobilization for 6 weeks is a viable treatment option.
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Affiliation(s)
- Denver B Kraft
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jason J Howard
- Division of Cerebral Palsy, Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
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Ventura M, Ferreira A, Rodrigues D, Cerqueira R, Santos M. Pediatric Lisfranc Fracture-Dislocation: A Case Report. Cureus 2022; 14:e29525. [PMID: 36312684 PMCID: PMC9590289 DOI: 10.7759/cureus.29525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/28/2022] Open
Abstract
Lisfranc injury is extremely rare in the pediatric population and little evidence exists to guide the treatment at this age. We present a clinical case of a rare Lisfranc fracture-dislocation at pediatric age. An 11-year-old male was admitted to the emergency department, in October 2020, after a motorcycle incident. He was diagnosed with a Lisfranc fracture-dislocation of the right foot: Myerson type B2. Fourteen days after the injury, he underwent surgical treatment with open reduction and internal fixation with 3.5 mm solid fully threaded screws. At 18 months postoperative, the patient was asymptomatic, didn’t present any limitations, presented an American Orthopedic Foot and Ankle Score (AOFAS) midfoot score of 93%, and excellent results of the 12-Item Short Form Survey (SF-12) - PCS-12 (Physical Score): 52.52277 and MCS-12 (Mental Score): 62.12820. The foot maintained a good configuration without significant malalignment, however, a screw breakage occurred before the implant removal, and a premature physeal arrest developed on the base of the first metatarsal bone. Clinical and radiographic evaluation of Lisfranc injuries may be challenging in the pediatric population. Regarding the treatment, anatomical alignment is mandatory, and good or excellent outcomes have been achieved with anatomical reduction and internal fixation. We recommend early implant removal to avoid screw breakage and avoid the use of screws in the first metatarsal physis, due to the risk of premature physeal arrest.
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Tougas C, Brimmo O. Common and Consequential Fractures That Should Not Be Missed in Children. Pediatr Ann 2022; 51:e357-e363. [PMID: 36098608 DOI: 10.3928/19382359-20220706-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Missed or delayed diagnosis of fractures in children is not uncommon owing to their immature skeletons, unique fracture patterns, and distinctive radiologic findings. The term occult is used to describe radiographically subtle fractures. Some of these fractures can be associated with excellent outcomes despite the pitfalls of delayed diagnosis. However, a subset of these injuries have more guarded prognoses when missed, despite their harmless radiographic appearance. A high index of suspicion should be maintained when treating pediatric extremity injuries with clinical findings disproportionate to a benign-appearing radiograph. Moreover, overreliance on radiology reports can perpetuate diagnostic error. In cases of discrepancy, timely follow-up for repeat examination or immediate advanced imaging can help avoid missed diagnoses. Most critically, the one diagnosis not to miss is nonaccidental trauma, as continued exposure to abuse puts the child at risk of further injury and death. [Pediatr Ann. 2022;51(9):e357-e363.].
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Cardile C, Cazzaniga C, Manzini B, Marasco R, Ragni P. Lisfranc injuries in adolescents: A case report and literature review. Foot (Edinb) 2021; 47:101812. [PMID: 33957527 DOI: 10.1016/j.foot.2021.101812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Lisfranc injuries result if bones or ligaments that support the midfoot are torn. In children and adolescents these injuries are not only rare, but are also similar to adult Lisfranc injuries, in that they are often mistaken especially if the injury is a result of a straightforward twist and fall. The goal of surgical treatment is to realign the joints. However, few studies related to Lisfranc injuries in pediatric patients exist. A case of 15 years old patient treated using an Arthrex mini tight rope is described.
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Affiliation(s)
- Carlo Cardile
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy.
| | - Carlo Cazzaniga
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
| | - Beatrice Manzini
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
| | - Roberto Marasco
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
| | - Paolo Ragni
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
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Kushare I, Wunderlich N, Elabd A, Attia E. Pediatric and adolescent Lisfranc injuries - Presentation, treatment and outcomes. Foot (Edinb) 2021; 46:101737. [PMID: 33853714 DOI: 10.1016/j.foot.2020.101737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Lisfranc fracture dislocations are rare injuries and even more so in the pediatric population. The main purpose of our study is to present a descriptive analysis of Lisfranc injuries in pediatric patients to add to the current sparse literature on this topic. In addition, our secondary outcome was to analyze any differences in patients treated conservatively versus operatively, and those with isolated Lisfranc injuries versus those with associated foot injuries. METHODS Charts of patients with Lisfranc injury treated at a tertiary pediatric hospital from January 2010 to July 2019 were reviewed to analyze their demographics, injury characteristics, management details and rehabilitation protocol. Functional outcome was assessed using the Visual Analogue Scale of Pain (VAS) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). RESULTS 30 patients/cases were included with mean age of 13.6 years and mean follow up of 36 weeks. 20% of the cases were missed on initial presentation. 19 cases were managed operatively while 11 were managed conservatively. The average OxAFQ-C and VAS pain scores were 83% and 1.3, respectively at mean follow-up of 36 weeks. The functional outcomes between conservative and operative cases or between those with isolated Lisfranc injuries and those with associated foot injuries were not statistically significant (p > 0.05). CONCLUSION Lisfranc injury in pediatrics can be easily missed. High index of suspicion, a thorough clinical examination and the use of advanced imaging is warranted. Various modalities like K-wires, screws and suture-buttons can be used for fixation. Early to mid-term functional outcomes are satisfactory provided that adequate reduction is obtained.
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Affiliation(s)
- Indranil Kushare
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
| | - Nicole Wunderlich
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Ahmed Elabd
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Elsayed Attia
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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Abstract
Foot and ankle pathology is common in the pediatric population. Common issues may be traumatic in nature, congenital, or age dependent. This article reviews common problems and pathology found in the pediatric foot and ankle.
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Affiliation(s)
- Aron Green
- Seaview Orthopedic & Medical Associates, 1200 Eagle Avenue, Ocean, NJ 07712, USA.
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7
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Early Upper Paleolithic human foot bones from Manot Cave, Israel. J Hum Evol 2019; 160:102668. [DOI: 10.1016/j.jhevol.2019.102668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 11/19/2022]
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Abstract
CLINICAL/METHODICAL ISSUE Due to mechanical loading and the number of joints involved, fractures of the foot are among the most common fractures. STANDARD RADIOLOGICAL METHODS X-ray is basis for diagnostic workup of all foot fractures. METHODICAL INNOVATIONS For stress fractures, the additional use of magnetic resonance imaging (MRI) is indicated. Computed tomography (CT) can be used for preoperative imaging of intraarticular tarsal fractures. PERFORMANCE Simple traumatic fractures can be reliably diagnosed by X‑ray. On the other hand, there is a poor sensitivity for stress fractures. ACHIEVEMENTS Using a combination of X‑ray, MRI, and CT, it is possible to reliably diagnosis and classify foot fractures. PRACTICAL RECOMMENDATIONS The first step to diagnose a foot fracture should be the X‑ray. CT and MRI can also be used to detect intra-articular fractures and MRI can be used for stress fractures.
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George MP, Bixby S. Frequently Missed Fractures in Pediatric Trauma: A Pictorial Review of Plain Film Radiography. Radiol Clin North Am 2019; 57:843-855. [PMID: 31076036 DOI: 10.1016/j.rcl.2019.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Missed fractures are common in pediatric trauma patients. Pediatric bone differs from adult bone in its composition and response to injury, leading to fracture patterns that may be subtle, radiographically unfamiliar, and challenging to distinguish from normal variation. Familiarity with the unique fracture types of the pediatric skeleton and site-specific injury patterns is critical, because prompt diagnosis can significantly alter clinical management and outcome. This article examines the unique features of pediatric bone contributing to missed fractures, the incidence of missed fractures, common injury types of the pediatric skeleton, and frequently missed site-specific fracture patterns, highlighting problem-solving techniques for challenging cases.
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Affiliation(s)
- Michael P George
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA.
| | - Sarah Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA
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Tzatzairis T, Firth G, Parker L. Adolescent Lisfranc injury treated with TightRope TM: A case report and review of literature. World J Orthop 2019; 10:115-122. [PMID: 30788228 PMCID: PMC6379736 DOI: 10.5312/wjo.v10.i2.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/14/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lisfranc injuries are rare and can be easily missed. This injury is extremely rare in children, with limited published data. Different treatment options have been described; one of the options in adults is the “mini” TightRope™ Syndesmosis Device that provides non-rigid fixation with impressive results. However, there is no reference regarding the use of this device in children.
CASE SUMMARY We describe the case of an 11-year-old girl who sustained a Lisfranc injury of her right foot that was initially missed in the Accident and Emergency department of her local hospital. This case was a ligamentous/periosteal sleeve avulsion type of Lisfranc injury and a percutaneous technique using the “mini” TightRope™ syndesmosis device was used. Clinical and radiological results were excellent at final follow up.
CONCLUSION The “mini” TightRope™ syndesmosis device is a promising method of fixation for children with certain Lisfranc injuries. This method has many advantages, including the non-rigid type of the fixation and no need for subsequent metalwork removal.
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Affiliation(s)
- Themistoklis Tzatzairis
- Royal London Hospital, Paediatric Orthopaedic Department, Barts NHS Trust, London E1 2AA, Whitechapel, United Kingdom
| | - Gregory Firth
- Royal London Hospital, Paediatric Orthopaedic Department, Barts NHS Trust, London E1 2AA, Whitechapel, United Kingdom
| | - Lee Parker
- Royal London Hospital, Foot and Ankle Orthopaedic department, Barts NHS Trust, London E13 8SL, United Kingdom
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Abstract
BACKGROUND Injuries to the Lisfranc joint in children and adolescents are rare. The incomplete ossification of the bones of the foot makes it difficult to detect injuries.The aim of this study was to determine age-specific radiographic measurements of the Lisfranc joint to provide guidance to the radiologist, emergency physicians, and surgeons to decrease misdiagnosis of Lisfranc injuries and improve detection. METHODS We retrospectively reviewed all foot radiographs without traumatic injury made between August 2014 and February 2015 in all patients younger than 18. The attendance list of the Emergency Department and Outpatient Clinic of a level-1 trauma center were used. Using a non-weight-bearing anteroposterior-view of the foot the distance between the base of metatarsal 1 and metatarsal 2 (MT1-MT2) and the distance between the medial cuneiform (MC) and the base of metatarsal 2 (MC-MT2) were measured. Median normal values were calculated per age. RESULTS A total of 352 patients between the age of 0 and 18 years were screened for eligibility. Excluded were 109 patients because of anatomic abnormality, a fracture, inadequate radiograph, pain at the base of the first metatarsal, second metatarsal or MC, persisting pain at the Outpatient Clinic checkup or no follow-up. Included in the analysis were 243 patients. CONCLUSIONS The distance between the base of MT1-MT2 was constant below 3 mm. Measurements for both MT1-MT2 and MC-MT2 distance approached adult values at the age of 6. LEVEL OF EVIDENCE Level III.
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Midfoot Degenerative Arthritis and Partial Fusion After Pediatric Lisfranc Fracture-Dislocation. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e004. [PMID: 30211381 PMCID: PMC6132315 DOI: 10.5435/jaaosglobal-d-17-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We present a case of a 10-year-old girl who sustained a Lisfranc fracture-dislocation after an all-terrain vehicle accident. She underwent open reduction and internal fixation with smooth Kirschner wires. At 5-year follow-up, she had developed functional pain and radiographic evidence of degenerative arthritis and partial fusion of her midfoot. There are several possible explanations for this outcome, including loss of reduction, traumatic or iatrogenic physeal injury, and severity of initial injury. Long-term outcomes in children with Lisfranc injuries are not well described. Our case may begin to shed light on the natural history of these injuries in the pediatric population, with the consideration of potential treatment implications and pitfalls.
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Abstract
In this descriptive analysis of pediatric Lisfranc injuries, records of 56 children treated for bony or ligamentous Lisfranc injuries over a 12-year period were reviewed. Overall, 51% of fractures and 82% of sprains were sports-related (P=0.03). A total of 34% of the cohort underwent open reduction internal fixation, which was more common among patients with closed physes (67%). Full weight bearing was allowed in open reduction internal fixation patients at a mean of 14.5 weeks, compared to 6.5 weeks in the nonoperative group. Complications were rare (4%) and included physeal arrest in one patient and a broken, retained implant in one patient.
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Fraturas do tornozelo e do pé na infância: revisão da literatura e evidências científicas para o tratamento adequado. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rammelt S, Godoy-Santos AL, Schneiders W, Fitze G, Zwipp H. Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment. Rev Bras Ortop 2016; 51:630-639. [PMID: 28050532 PMCID: PMC5198067 DOI: 10.1016/j.rboe.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.
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Affiliation(s)
- Stefan Rammelt
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
| | - Alexandre Leme Godoy-Santos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Wolfgang Schneiders
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
| | - Guido Fitze
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
| | - Hans Zwipp
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
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17
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Wagle S, Phelps AS, MacKenzie JD. “Weak Links” of the Pediatric Skeleton: Common Foci for Disease and Trauma. Part 2—Areas of Weakness Beyond Bone and Cartilage Transitions. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-015-0135-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Musculoskeletal: what is different in children? Jumped off of a merry-go-round: immediate crying and cannot walk on the left leg. Emerg Radiol 2015; 22 Suppl 1:17-8. [DOI: 10.1007/s10140-014-1254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022]
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Musculoskeletal: what is different in children? Playing in “bouncy house”: injures foot: pain for 1 week. Emerg Radiol 2015; 22 Suppl 1:25-7. [DOI: 10.1007/s10140-015-1307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
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Musculoskeletal: what is different in children? Riding on his dirt bike—falls: foot trapped on ground. Emerg Radiol 2015; 22:423-4. [DOI: 10.1007/s10140-013-1148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Injuries around the foot and ankle are challenging. There is a paucity of literature, outside that of specialist orthopedic journals, that focuses on this subject in the pediatric population. DATA SOURCES In this review, we outline pediatric foot and ankle fractures in an anatomically oriented manner from the current literature. Our aim is to aid the emergency department doctor to manage these challenging injuries more effectively in the acute setting. RESULTS These injuries require a detailed history and examination to aid the diagnosis. Often, plain radiographs are sufficient, but more complex injuries require the use of magnetic resonance imaging. Treatment is dependent on the proximity to skeletal maturity and the degree of displacement of fracture. Children have a marked ability to remodel after fractures and therefore mainstay treatment is immobilization by a cast or splint. Operative fixation, although uncommon in this population, may be necessary with adolescents, certain unstable injuries or in cases with displaced articular surface. In the setting of severe foot trauma, skin compromise and compartment syndrome of the foot must be excluded. CONCLUSION The integrity of the physis, articular surface and soft tissues are all equally important in treating these injuries.
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Rammelt S, Schneiders W, Fitze G, Zwipp H. [Foot and ankle fractures in children]. DER ORTHOPADE 2013; 42:45-54. [PMID: 23306525 DOI: 10.1007/s00132-012-1993-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Ankle fractures are the most frequent factures of weight-bearing joints in children while fractures of the hindfoot and midfoot are rare. Metatarsal fractures make up the greatest portion of foot fractures in children and mostly heal uneventfully. Generally, the fracture severity increases with increasing age and the fracture patterns in adolescents resemble those in adults but transitional fractures of the distal tibial epiphysis in adolescents between 12 and 14 years of age are an exception. A subtle clinical and radiographic examination is necessary to detect the injury pattern and to discriminate fractures from accessory bones, juvenile avascular necrosis and apophyses. Computed tomography scanning is most useful to precisely evaluate the degree of injury, especially articular involvement and to allow precise planning of the operative approach. Except for the calcaneus and the metatarsals the bones of the foot and ankle do not display a significant potential for spontaneous correction during growth; therefore, open reduction and internal fixation is indicated in all displaced fractures if closed reduction does not yield a satisfying result in order to avoid relevant post-traumatic deformities.
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Affiliation(s)
- S Rammelt
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Lievers WB, Frimenko RE, Crandall JR, Kent RW, Park JS. Age, sex, causal and injury patterns in tarsometatarsal dislocations: a literature review of over 2000 cases. Foot (Edinb) 2012; 22:117-24. [PMID: 22560256 DOI: 10.1016/j.foot.2012.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/09/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND The causes and mechanisms of tarsometatarsal (TMT) dislocations are poorly characterized. Unfortunately, the rarity of these injuries makes it difficult and costly to gather the epidemiological data needed to better understand the populations at risk and the circumstances under which injury is most likely to occur. METHODOLOGY To address this issue, literature reports of TMT dislocations were identified and analyzed to generate statistical descriptions of the common causes of injury, the age and sex of those injured, and the pattern of injury. Over 2000 injuries were identified from 187 articles. RESULTS The analysis reveals that over 40% of injuries were related to traffic accidents. Based on the Hardcastle classification system, more than 60% of TMT dislocation were partial (type B) injuries. Over 55% of the injured were between 15 and 35 years of age, and males were injured more than twice as frequently. Conversely, the victims of falls tended to be older and represented a larger proportion of females. The age and sex of those injured by TMT dislocations vary by cause. CONCLUSION An improved understanding of the epidemiologic patterns will benefit research into the mitigation and prevention of these injuries.
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Affiliation(s)
- W Brent Lievers
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA 22901, USA.
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Musculoskeletal what’s different in children: playing; injury to ankle/foot; limping. Emerg Radiol 2012; 19:87-8. [DOI: 10.1007/s10140-011-0943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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Abstract
Tarsometatarsal joint injuries are well described in adults. In children, these injuries have been less described and have been reported only as small case series. They frequently go unrecognized in children because of skeletal immaturity and lack of awareness among health care providers. However, these injuries if untreated can result in significant pain and deformity in children. It is important that treating physicians recognize the symptoms and signs of these injuries and initiate further diagnostic workup, especially when there is persistent foot pain in the absence of radiographic signs of a fracture. We present a case of an 11-month-old female infant who presented with foot pain after a fall.
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Musculoskeletal: what is different in children? Jumped off bed; foot pain. Emerg Radiol 2009; 16:171-4. [DOI: 10.1007/s10140-008-0765-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 08/27/2008] [Indexed: 11/30/2022]
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Yap L, Yates E, Ul-Haque M, Sarin R. Lisfranc fracture dislocation in a child. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0456-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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D'Souza AL, Smith GA, McKenzie LB. Bunk bed-related injuries among children and adolescents treated in emergency departments in the United States, 1990-2005. Pediatrics 2008; 121:e1696-702. [PMID: 18519473 DOI: 10.1542/peds.2007-2555] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to comprehensively examine bunk bed-related injuries in the United States by using a nationally representative sample. METHODS Using the National Electronic Injury Surveillance System database, cases of nonfatal bunk bed-related injuries treated in US emergency departments from 1990 through 2005 were selected by using the National Electronic Injury Surveillance System bunk bed product code (0661). Cases concerning individuals </=21 years old were included. RESULTS An estimated 572 580 children and adolescents aged </=21 years were treated in US emergency departments for bunk bed-related injuries during the 16-year study period, yielding an average of 35 790 cases annually. An average of 42 per 100 000 population were treated annually. Bunk bed-related injuries occurred more frequently among males (60.6%). Lacerations were the most common type of injury (29.7%), followed by contusions and abrasions (24.0%) and fractures (19.9%). The body parts most frequently injured were the head and neck (27.3%) in all age groups. Falls were the most common mechanism of injury (72.5%). Of the cases for which locale of injury was recorded, 93.5% occurred at home. Approximately half of the bunk bed-related injuries that occurred at schools involved individuals aged 18 to 21 years (50.9%). An estimated 2.9% of injuries resulted in hospitalization or transfer to another hospital or required additional observation. The number of bunk bed-related injuries showed no significant trend from 1990 to 2005. CONCLUSIONS Bunk beds are a common source of injury among children and adolescents, and these injuries mostly involve the head and face. Given the continuing large numbers of bunk bed-related injuries at homes and in schools, increased efforts are needed to prevent bunk bed-related injuries among children and adolescents.
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Affiliation(s)
- Anjali L D'Souza
- Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Department of Pediatrics, Ohio State University, College of Medicine, 700 Children's Dr, Columbus, OH 43205, USA
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Commonly missed subtle skeletal injuries in children: a pictorial review. Emerg Radiol 2008; 15:391-8. [DOI: 10.1007/s10140-008-0733-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 04/16/2008] [Indexed: 10/22/2022]
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Swischuk LE. The limping infant: imaging and clinical evaluation of trauma. Emerg Radiol 2007; 14:219-26. [PMID: 17566800 DOI: 10.1007/s10140-007-0628-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 05/04/2007] [Indexed: 11/29/2022]
Abstract
Limping, due to trauma, is common in all age groups, but this dissertation deals with limping in infants to about 3 years of age. The reason for this age cut-off is that, often, it is difficult to obtain an accurate history from these patients, and thus, imaging becomes of paramount importance. This being said, it is important that the individual evaluating the images knows what to look for and what it looks like.
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Affiliation(s)
- Leonard E Swischuk
- Pediatric Radiology, Radiology Department, The University of Texas Medical Branch, Galveston, TX, USA.
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Swischuk LE, Hernandez JA. Frequently missed fractures in children (value of comparative views). Emerg Radiol 2004; 11:22-8. [PMID: 15278701 DOI: 10.1007/s10140-004-0362-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 05/21/2004] [Indexed: 10/26/2022]
Abstract
Fractures in infants and children are different to those seen in adults. Many are very subtle and difficult to detect with certainty. Furthermore, variations in bone contour and epiphyseal plate configuration are endless and at first may suggest pathology. Comparative views are therefore invaluable and are emphasized throughout this communication, which deals with: (1) plastic bending fractures, (2) hairline fractures, (3) impaction fractures, (4) subtle epiphyseal-metaphyseal Salter-Harris fractures, and (5) subtle angle buckle fractures. Helpful points to assist one in detecting these fractures are presented.
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Affiliation(s)
- Leonard E Swischuk
- Department of Radiology, The University of Texas Medical Branch, Galveston, TX 77555, USA.
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Abstract
Foot fractures account for 5% to 8% of all pediatric fractures and for approximately 7% of all physeal fractures. A thorough understanding of the anatomy of the child's foot is of central importance when treating these injuries. Due to the difficulties that may be encountered in obtaining an accurate physical examination of a child with a foot injury and the complexities of radiographic evaluation of the immature foot, a high index of suspicion for the presence of a fracture facilitates early and accurate diagnosis. Although the treatment results in pediatric foot trauma are generally good, potential pitfalls in the treatment of Lisfranc fractures, talar neck and body fractures, and lawn mower injuries to the foot must be anticipated and avoided if possible.
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Affiliation(s)
- R M Kay
- Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA
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Abstract
We are reporting a series of eight patients ranging in age from 3 to 10 years who sustained plantar-flexion injuries of the foot, resulting in injuries to the tarsometatarsal (TMT) interval. All injuries were identified within 3 days and treated with molded short leg immobilization. We evaluated all patients an average of 32 months after injury with physical examination and the Midfoot Functional Rating (MFR) score. Seven patients had no limitations in their activities of daily living or athletic endeavors. These seven patients had MFR scores of 100. One patient had complaints of midfoot pain with running for >5 min and radiographic evidence of degenerative changes across the TMT interval at 3-year follow-up. These results suggest that although indirect pediatric TMT injuries have a generally favorable prognosis, early degenerative changes can occur and may be responsible for chronic pain and activity limitation. Degenerative changes in this weight-bearing region in a young patient can have lifelong implications. Patients and parents may benefit from discussion of the potential for future midfoot compromise following this injury.
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Swischuk LE. I stepped in a hole and can't walk. Pediatr Emerg Care 2000; 16:213-4. [PMID: 10888465 DOI: 10.1097/00006565-200006000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L E Swischuk
- Department of Radiology, The University of Texas Medical Branch, Children's Hospital, Galveston 77555-0709, USA
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Abstract
In this presentation, the common clinical pediatric problems (appendicular growth aberrations, hip pain, back pain, some aspects of trauma, and inflammatory and infectious processes that can be addressed by nuclear imaging will be discussed. The accurate interpretation of bone scintigraphy in the evaluation of pediatric orthopedic conditions depends on the use of appropriate radiopharmaceuticals and imaging techniques specific for the pediatric population, a knowledge of physiologic changes in the growing skeleton, as well as the different disease processes peculiar to each age bracket. The physes (growth-plates) will be discussed in detail because they are the most active portion of the pediatric skeleton. Their activity (potential for growth) can be altered by physiologic, developmental aberrations (varus and valgus) and pathologic conditions (trauma, infection, etc.).
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Affiliation(s)
- G A Mandell
- Department of Medical Imaging, duPont Hospital for Children, Wilmington, DE 19899, USA
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Abstract
The incidence and severity of fractures and dislocations vary depending on their location and on the direction of the forces responsible for the injury. The radiologist's role in evaluation of the injured foot is to recognize the types of injuries produced by particular forces. Because there is considerable overlap of fractures and dislocations of the foot and ankle, evaluation of one area to the neglect of the other can lead to significant oversights and failure to recognize additional injury patterns. For example, fractures of the talus, calcaneus, base of the fifth metatarsal, and to a lesser extent, the cuboid and navicular bones may masquerade as ankle sprains or malleolar injuries. The most important aspects to correct interpretation of traumatized foot radiographs are (1) pertinent clinical history, (2) a complete radiographic series, and (3) detection of soft-tissue swelling or injury.
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Affiliation(s)
- D Karasick
- Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19107
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