兒童橈骨頸骨折治療ppt課件

1、Radial Neck Fracturesin Children Treated With ElasticStable Intramedullary NailingNingbo No. 6 hospital Caojin Anatomy Characteristic begins at four years and it fuses at the age of 14 in females and 17 in males.Ossification centerCharacteristic age 414years disease rate: 5% of elbow injuries or 1%

2、of all injuries in chindren Mechanism Elbow in extension :more common typeElbow in flexed:rare typeD Wilkins E history symptom physical sign radiographlcontroversylacceptable degrees 1545lthe majority opinion 30Reduction vClosed reductionvPercutaneous pin reductionvOpen recuctionClosed reduction30 6

3、060Percutaneous pin reduction Risk :radial nerve injuryOpen reduction controversial outcomes incidence of complication causes additional damage open reductionTecnique of elastic nailingPostoperative radiographCase 1 A 6-year-old boy sustained a Judet type IV fracture of the radial neck. Follow-up ra

4、diograph after elastic nailing shows good reduction.The patient had an excellent outcome.Case 1 Follow-up radiograph shows fracture union and anatomic reduction.The patient showed an excellent clinical result and resumed full motion.Case 2 10-year-old boy sustained a Judet type IV fracture of the ra

5、dial neck. Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.Anatomy By four years of age, the radial head and neck 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 i

6、n 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 proximal.Mechanism 2 main mechanisms of injury were described in literature. In the more common type, a radial neck fracture occurs after a fall wi

7、th 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, which causes temporary and posterior dislocation of the elbow joint.lThere is still some controversy about management of radial neck fractures in chi

8、ldren. lAcceptable degrees of angulation range from 15 to 45 degrees.lWe agree with the majority who recommend treating fractures with an angulation of less than 30 degrees with immobilization alone and those with more than 30 degrees angulation by means of surgery.Reduction vThe severely angulated

9、fractures can be treated with closed reduction, percutaneous reduction, and open Reduction.Open reduction open reduction is controversial.Traditionally, it was performed if closed manipulation 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,