소아 족관절 골절: 분류와 치료 방법 = Ankle Fractures in Children: Classification and Treatment

국문 초록 (Abstract)

소아 족관절 골절은 경비골 원위부의 골간단, 성장판 및 골단에 대한 손상으로 정의된다. 소아 족관절 골절은 손상 기전이 성인과 유사하다고 하더라도 골단판이 경골과 비골의 원위부에 위치하기 때문에 골절의 형태뿐만 아니라 치료 방법이 성인과 다르다. 소아의 인대는 성장판 연골보다 강해서, 성인에서 염좌를 일으킬 정도의 부하가 소아에서는 주로 성장판 골절을 일으키고, 사춘기에는 원위 경골 성장판의 폐쇄가 진행되는 동안 이행기 골절이 발생된다. 진단을 위해서는 방사선 검사가 필수적이고 인대 손상이 의심될 때에는 스트레스 사진이나 초음파, 자기공명영상 촬영이 사용될 수 있다. 치료의 목표는 관절면 일치(articular congruity)와 골 정렬을 회복하여 기능을 보존할 뿐만 아니라 골단판을 보호, 유지시키는 것이다. 성장판 골절은 해부학적 정복 후에도 조기 성장판 폐쇄가 흔하게 발생하고 각변형과 부정유합, 수상 후 관절염 등의 합병증이 발생할 수 있어 이에 대한 보호자 설명과 장기 추시가 필수적이다.

다국어 초록 (Multilingual Abstract)

Pediatric ankle fractures are defined as damage to the metaphysis, epiphyseal plate, and epiphysis of the distal tibia and fibula. Although the injury mechanism could be similar, the fracture patterns and treatment of pediatric ankle fractures are different from those of adults. In children, growth plate injuries are more common with a force that would cause sprains in adults because the ligaments are stronger than the growth plate cartilage in children. In the adolescent period, unique fractures, called “transitional fractures”, occur while the physis is closed. For a diagnosis, plain images of the anteroposterior, lateral, and mortise views are essential. Stress radiographs, ultrasound, and magnetic resonance imaging can be used for suspected ligament injuries. The treatment goal is to restore the articular congruity, normal bony alignment, and preserve the epiphyseal plate to ensure normal growth. Pediatric ankle fractures frequently lead to premature physeal arrest, angular deformities, malunion, and post-traumatic arthritis even after anatomic reduction. Treating surgeons should follow-up children for a sufficient time and explain to the caregiver the possible complications before treatment.

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