儿童桡骨颈骨折治疗课件.ppt

1、Radial Neck Fracturesin Children Treated With ElasticStable Intramedullary NailingNingbo No.6 hospital Caojin 儿童桡骨颈骨折治疗Anatomy 儿童桡骨颈骨折治疗Characteristic begins at four years and it fuses at the age of 14 in females and 17 in males.Ossification center儿童桡骨颈骨折治疗Characteristic age 414years disease rate:5%

2、of elbow injuriesor 1%of all injuries in chindren 儿童桡骨颈骨折治疗Mechanism Elbow in extension:more common typeElbow in flexed:rare type儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗D Wilkins E儿童桡骨颈骨折治疗 history symptom physical sign radiographReduction vClosed reductionvPercutaneous pin reductionvOpen recuction儿童桡骨颈骨折治疗Closed reducti

3、on30 6060儿童桡骨颈骨折治疗Percutaneous pin reduction Risk:radial nerve injury儿童桡骨颈骨折治疗Open reduction controversial outcomes incidence of complication causes additional damage open reduction儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗Tecnique of elastic nailing儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗Postoperative radiograph儿童桡骨颈骨折治疗Case 1 A 6-year-old boy

4、 sustained a Judet type IV fracture of the radial neck.Follow-up radiograph after elastic nailing shows good reduction.The patient had an excellent outcome.儿童桡骨颈骨折治疗Case 1 Follow-up radiograph shows fracture union and anatomic reduction.The patient showed an excellent clinical result and resumed ful

5、l motion.儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗Case 2 10-year-old boy sustained a Judet type IV fracture of the radial neck.儿童桡骨颈骨折治疗 Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗Anatomy By four years of age,the radial head and neck

6、 have assumed their adult shape with a physiological angulation of the neck in the anteroposterior(AP)plane of an average of 12.5 laterally and in the lateral plane of an average of 3.5 anteriorly.The proximal radial epiphysis is mainly supplied by periosteal blood vessels running from distal to pro

7、ximal.儿童桡骨颈骨折治疗Mechanism 2 main mechanisms of injury were described in literature.In the more common type,a radial neck fracture occurs after a fall with the elbow in extension and valgus,resulting in a fracture with valgus angulation.In the rare type,the mechanism is a fall with the elbow flexed,wh

8、ich causes temporary and posterior dislocation of the elbow joint.儿童桡骨颈骨折治疗Reduction vThe severely angulated fractures can be treated with closed reduction,percutaneous reduction,and open Reduction.儿童桡骨颈骨折治疗Open reduction open reduction is controversial.Traditionally,it was performed if closed manip

9、ulation failed.in general,outcomes after open reduction are worse than those obtained after closed reduction.after open reduction,the incidence of complication,is higher than those after closed reduction.open reduction causes additional damage to the soft tissue,with fibrous adhesions and loss of range of motion.Some radial neck fractures are impossible to reduce with closed methods,requiring open reduction儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗