一例婴儿锁骨再骨折病例报告以及患儿锁骨骨折回顾

medline  2013年8月21日  阅读数:2457  字体:    

Refracture of the Clavicle in an Infant: Case Report and Review of Clavicle Fractures in Children

一例婴儿锁骨再骨折病例报告以及患儿锁骨骨折回顾

 

Case Report

A 9-month-old boy was evaluated for a recurrent lump on his right clavicle. His medical history was significant for a fracture of the right mid-clavicle diagnosed at 2 weeks of age via a radiograph (Figure 1) when the mother noticed an asymptomatic lump in the clavicular area. The child was born via a normal, spontaneous vaginal delivery at a weight of. He lived at home with his mother, father, and two healthy, well-appearing older siblings.

病例报道

一名9个月大的男孩右侧锁骨处被鉴定为复发性肿块。当母亲注意到他的锁骨处有无症状性肿块时,医师在其出生两周后,通过射线照片(图1)诊断出他的右侧锁骨中干骨折,这一病史很重要。该患儿经正常、自然分娩,出生时体重为3.9 kg。他跟父母以及两个健康兄长住在家里。

At this 9-month visit, his physical examination was completely normal, except for a small, firm, slightly tender protuberance of his right mid-clavicle. A radiograph revealed a lucency extending from the superior cortex to the inferior cortex of the clavicle, consistent with a new fracture (Figure 2). This new fracture was just medial to the area of the previously healed perinatal fracture.

9个月访视时,除右侧锁骨中干处出现较小、轻微柔软的肿胀外,体格检查完全正常。射线照片显示锁骨上皮层到下皮层有一明亮的延伸,符合新发骨折(图2)。新发骨折刚好处于此前愈合的围产期骨折处。

The boy had recently begun to pull to stand and ambulate while holding onto a low table. His caregivers did not witness one specific severe fall by the boy, but did witness multiple seemingly insignificant falls in which he could have fallen against die table or a toy. Due to the infant's young age and the fact that no definitive cause of the second fracture was determined, the child was admitted to the hospital for further evaluation. A skeletal survey revealed no other bony abnormalities except for the previously stated clavicle findings.

该患儿最近抓住矮桌子开始拉伸站立和走动。看护人没有看到过男孩有特别严重摔倒的情况,但是目睹过其多次看似无关紧要的摔倒(被模型表或玩具绊倒)。考虑到患儿的年龄以及尚不明确第二次骨折的原因,该患儿被送往医院进行进一步评定。骨骼检查显示除以前已经确定的锁骨骨折外,没有其他骨骼异常。

An investigation by Child Protective Services concluded that intentional injury was unlikely to be the cause of the fractured clavicle. The most plausible explanation was that the perinatally injured clavicle may have been at increased risk of fracturing, and a fall onto the shoulder by the newly ambulating toddler caused the refracture. Another radiograph obtained 2 weeks after the discovery of the second clavicle fracture showed development of a callus in the affected area (Figure 3).

依据儿童保护服务机构的一项调查推断故意伤害不可能是锁骨骨折的原因。最合理的解释是围产期受损伤的锁骨可能增加了再骨折的风险。蹒跚学步的幼儿摔倒,碰到肩部,导致再骨折。在第二次锁骨骨折发现的两周之后,射线照片显示骨折部位长出骨痂。

Figure 1. Periosteal reaction surrounding a midshaft fracture of the right clavicle (patient at 2 weeks of age).

图1.围绕右侧锁骨中干骨折的骨膜反应(出生两周的患儿)

Figure 2. A lucency extends from the superior to inferior cortices of the right clavicle, indicative of a second fracture

图2.右侧锁骨处上皮层到下皮层的明亮延伸,标示第二次骨折

 

  Figure 3. Interval development of callus around the second fracture

图3.第二次骨折处周围的骨痂间隔性发展

责任编辑:李锡海