儿童桡骨颈骨折治疗教学课件

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

2、all injuries in chindren Mechanism Elbow in extension :more common typeElbow in flexed:rare typeClassification Judet DWilkins EDiagnosis historysymptomphysical signradiographTreatment controversyacceptable degrees 1545the majority opinion 30Reduction Closed reductionPercutaneous pin reductionOpen re

3、cuctionClosed reduction30 6060Percutaneous pin reductionRisk :radial nerve injuryOpen reductioncontroversialoutcomesincidence of complicationcauses additional damageopen reductionFixation K-wiresElastic nailingTecnique of elastic nailingPostoperative radiographCase 1A 6-year-old boy sustained a Jude

4、t type IV fracture of the radial neck. Follow-up radiograph after elastic nailing shows good reduction.The patient had an excellent outcome.Case 1Follow-up radiograph shows fracture union and anatomic reduction.The patient showed an excellent clinical result and resumed full motion.Complication Infe

5、ctionelbow stiffnessavascular necrosispremature physeal closureAdvantage of ESINminimally invasive techniquestable fixationearly mobilizationanatomical reductionlower complication rategood-to-excellent resultsCase 2 10-year-old boy sustained a Judet type IV fracture of the radial neck.Postoperative

6、radiograph shows anatomic reduction.The patient showed a minimal incision.Thank YouThank YouThank YouAnatomy 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

7、 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 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

8、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.Treatment There is still some controversy about management of radial neck fracture

9、s in children. Acceptable degrees of angulation range from 15 to 45 degrees.We 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 The severely angul

10、ated fractures can be treated with closed reduction, percutaneous reduction, and open Reduction.Open reductionopen 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.a

11、fter 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 reductionAdvantage of ESINESIN is a minimally invas