尺骨鹰嘴骨折AO治疗原则.pptx

1、Olecranon fracture,Shandong Provincial Hospital,Introduction,Introduction,The olecranon is close to the skin and is prone to fracture under direct violence. Ulnar olecranon fracture caused by hyperextension and torsion is the most common type of elbow injury.,Introduction,Olecranon fracture can lead

2、 to severe dysfunction, arising from posttraumatic instability, impingement, soft-tissue contracture, malunion, or nonunion. To allow early motion of the elbow, it is essential to achieve precise and stable anatomical reconstruction of the different ring structures that make up this anatomy,1、Fractu

3、re and soft tissue assessment,Olecranon fractures are typically transverse and oblique type B1 fractures in which elbow extensors are destroyed by bending stresses acting on the distal humerus. With the increase of external force, the central part of olecranon articular surface may be comminuted and

4、 compressed, and even the avulsion fracture of coronal process may occur. The patient complained of pain and unable to move the elbow joint. The local skin presented swelling, congestion or contusion.,Note: The involution of radial head and humeral head must be carefully evaluated to identify whethe

5、r there is displacement or instability. Simple transverse or oblique fractures are not necessarily stable because they can be associated with dislocation of the elbow or forearm.,Most olecranon fractures need open reduction and internal fixation. For cases with extended elbow devices intact and with

6、out displacement, non operative treatment can be chosen. In view of the eccentric traction of triceps tendon, the fixation of fracture needs to follow the tension band principle.,2、Treatment plan,3、Preoperative plan,3、Preoperative planPosition and surgical approach,The posterior approach was used to

7、 cut the skin incision from the supracondylar fracture of the humerus to the distal end of the fracture 45cm. The incision can slightly bend to the radial side to protect the ulnar nerve and avoid contusion and laceration of the skin. Too large flap may cause difficulty in healing and should be avoi

8、ded. Since splitting the elbow muscle fibers may result in loss of innervation, it is necessary to strip the elbow muscle close to the ulna and expose the elbow joint.,3、Preoperative planReset technology and instruments,For fractures, involving the Joint, Direct Reduction can be achieved with Bone H

9、ook Point Reduction forceps Kirschner Wire,3、Preoperative planSelection of internal plants and principle of tension band,Simple transverse or oblique fractures, two Kirschner wires (1.8 mm or 1.6 mm) were used as internal splints and one or two stainless steel wires (1 mm or 2 mm) were circumscribed

10、. Oblique fracture should be fixed with 1 screws to achieve balanced pressure. For comminuted fractures and fractures involving the distal coronoid process, the posterior plate (1/3 tubular plate, reconstruction plate or 3.5mm LCP) is preferable, and the shaping 3.5mm olecranon anatomical LCP is als

11、o preferable.,4、Surgical skills,After flushing and clearing the joint cavity, the fragment should be repositioned, and the compressed joint surface must be fully raised to restore the anatomical structure. For oblique fractures, in order to prevent displacement, one lag screw may be inserted perpend

12、icular to the fracture line before tension band fixation. For complex comminuted fractures, indirect reduction is preferable: 3.5mm LCP or remodeled proximal ulnar reconstruction plate is optional for the implant. The proximal screws should be placed in the direction of the pulp cavity and perpendic

13、ular to other screws to form an interlocking structure.,5、Postoperative treatment,In the first 24-48 hours after the operation, the use of rear brace can increase patient comfort, but it is not necessary. If the fracture ends are stable, the patient can safely exercise the affected limb. A few days

14、after the operation, active function training can be carried out under auxiliary. Within 1 week after operation, active functional exercise should be closely monitored to avoid contracture of the elbow joint.,6、Hidden trouble and complication,Kirschner wire withdrew and ejection skin. Pain Fracture nonunion, rare,7、Clinical efficacy,Most ulnar ol