髌骨纵行骨折的误诊原因及防范对策

目的 分析髌骨纵行骨折的临床特点及误诊原因,总结防范误诊措施.方法 对2018年1月—2020年5月收治的16例髌骨纵行骨折中曾误诊5例的临床资料进行回顾性分析.结果 本组误诊率为31.25％,4例因单侧膝关节肿痛伴稍许伸屈活动受限入院,1例因车祸致左膝关节肿痛、活动受限入院.误诊为膝关节软组织损伤2例,股骨髁间骨...

Misdiagnosis Causes of Longitudinal Patella Fractures and Preventive Measures

Objective To analyze the clinical characteristics and misdiagnosis causes of longitudinal fracture of the patella,and to summarize the measures to prevent misdiagnosis.Methods The clinical data of 5 misdiagnosed cases in 16 cases with longitudinal patellar fractures admitted from January 2018 to May 2020 were retrospectively analyzed.Results The misdiagnosis rate in this group was 31.25%.Four cases were admitted to the hospital due to unilateral knee joint swelling and pain with slight limitation of extension and flexion,and 1 case was admitted to the hospital due to left knee joint swelling and pain and limitation of motion caused by traffic accident.Of them,2 cases were misdiagnosed as knee joint soft tissue injury,1 case as femoral intercondylar fracture,1 case as meniscus injury,and 1 case as synovial fold injury.The duration of misdiagnosis was 2-14(6.04±0.16)days.According to the misdiagnosed disease,the corresponding treatment was far from satisfactory,or the related examinations were performed due to further aggravation.All patients were diagnosed as longitudinal patella fracture.After diagnosis,4 cases underwent external fixation of the long leg cast on the back of the affected limb.The cast was removed in 3 to 4 weeks.The affected limb was improved after active functional exercise and the patient was discharged.Another case underwent a small incision on the lateral side of the patella.The modified tension band was fixed horizontally,and patients was discharged after recovery.Five patients were followed up for six months after discharge,and their functions recovered.Conclusion The incidence of longitudinal patella fractures is low.Due to lack of typical clinical symptoms and signs,it is often missed during initial diagnosis.Doctors should improve their awareness of the disease,improve physical examination and related imaging examinations,accurately grasp the main positive signs in the diagnosis of the disease,and emphasize the importance and necessity of axial X-rays of the patella to reduce the rate of clinical misdiagnosis.