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Barefoot stubbing injuries to the great toe in children: a new classification by injury mechanism.

Authors
Park, DY | Han, KJ  | Han, SH | Cho, JH
Citation
Journal of orthopaedic trauma, 27(11). : 651-655, 2013
Journal Title
Journal of orthopaedic trauma
ISSN
0890-53391531-2291
Abstract
OBJECTIVE: This study was conducted to categorize barefoot stubbing injuries to the great toe in children by injury mechanism to differentiate benign stubbing injuries from more complex injuries necessitating surgery.



DESIGN: Prospective clinical series of consecutively treated patients.



SETTING: Tertiary university hospital setting.



PATIENTS: Forty-one children who had sustained an indirect injury to the great toe during barefoot sports activities between January 2001 and December 2009 were included.



INTERVENTION: Conservative or surgical treatment was done according to clinical and radiological findings.



MAIN OUTCOME MEASUREMENT: Information regarding injury mechanism was collected from patients, parents, and coaches using skeletal models and assessed by a pediatric orthopedic surgeon. Mechanisms of injury were identified and grouped as follows: hyperabduction-flexion, hyperflexion, hyperabduction-extension, hyperextension, and hyperextension-adduction.



RESULTS: Hyperabduction-flexion was the most common mechanism (n = 16), in which interphalangeal joint dislocation and skin disruption was noted in most cases. The second most common mechanism was hyperabduction-extension (n = 14) in which avulsion fracture of the lateral volar condyle of the proximal phalanx was noted in most cases. This avulsion fracture had the worst prognosis after conservative care.



CONCLUSIONS: Based on these results, we have created a grading system and treatment protocol for indirect hallux sports injuries in children. Avulsion fracture of the lateral condyle of the proximal phalanx, a result of hyperabduction-extension, is a high-risk sign of nonunion and should be aggressively treated, contrary to previous guidelines.



LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DOI
10.1097/BOT.0b013e31828e5d39
PMID
23454860
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Orthopedic Surgery
Ajou Authors
조, 재호  |  한, 경진
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