儿童桡骨颈骨折治疗课件

RadialNeckFractures

inChildrenTreatedWithElastic

StableIntramedullaryNailingNingboNo.6hospital

Caojin儿童桡骨颈骨折治疗RadialNeckFractures

inChild1Anatomy儿童桡骨颈骨折治疗Anatomy儿童桡骨颈骨折治疗2Characteristicbeginsatfouryearsanditfusesattheageof14infemalesand17inmales.Ossificationcenter儿童桡骨颈骨折治疗Characteristicbeginsatfoury3Characteristicage

4～14yearsdiseaserate:5%ofelbowinjuriesor1%ofallinjuriesinchindren

儿童桡骨颈骨折治疗Characteristicage4～14year4MechanismElbowinextension:morecommontypeElbowinflexed:raretype儿童桡骨颈骨折治疗MechanismElbowinextension:5ClassificationJudet儿童桡骨颈骨折治疗ClassificationJudet儿童桡骨颈骨折治6DWilkins

E儿童桡骨颈骨折治疗DWilkinsE儿童桡骨颈骨折治疗7Diagnosishistorysymptomphysicalsignradiograph儿童桡骨颈骨折治疗Diagnosishistory儿童桡骨颈骨折治疗8Treatmentcontroversyacceptabledegrees15°~45°themajorityopinion30°儿童桡骨颈骨折治疗Treatmentcontroversy儿童桡骨颈骨折治疗9ReductionClosedreductionPercutaneouspinreductionOpenrecuction儿童桡骨颈骨折治疗ReductionClosedreduction儿童桡骨10Closedreduction30°～60°＞60°儿童桡骨颈骨折治疗Closedreduction儿童桡骨颈骨折治疗11PercutaneouspinreductionRisk:radialnerveinjury儿童桡骨颈骨折治疗PercutaneouspinreductionRisk12Openreductioncontroversialoutcomesincidenceofcomplicationcausesadditionaldamageopenreduction儿童桡骨颈骨折治疗Openreductioncontroversial儿童桡13FixationK-wiresElasticnailing儿童桡骨颈骨折治疗FixationK-wiresElasticn14Tecniqueofelasticnailing儿童桡骨颈骨折治疗Tecniqueofelasticnailing儿童桡15儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗16Postoperativeradiograph儿童桡骨颈骨折治疗Postoperativeradiograph儿童桡骨颈骨17Case1A6-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Follow-upradiographafterelasticnailingshowsgoodreduction.Thepatienthadanexcellentoutcome.儿童桡骨颈骨折治疗Case1A6-year-oldboysustain18Case1Follow-upradiographshowsfractureunionandanatomicreduction.Thepatientshowedanexcellentclinicalresultandresumedfullmotion.儿童桡骨颈骨折治疗Case1Follow-upradiographsho19ComplicationInfectionelbowstiffnessavascularnecrosisprematurephysealclosure儿童桡骨颈骨折治疗ComplicationInfection儿童桡骨颈骨折治20AdvantageofESINminimallyinvasivetechniquestablefixationearlymobilizationanatomicalreductionlowercomplicationrategood-to-excellentresults儿童桡骨颈骨折治疗AdvantageofESINminimallyinv21Case210-year-oldboysustainedaJudettypeIVfractureoftheradialneck.儿童桡骨颈骨折治疗Case210-year-oldboysustain22Postoperativeradiographshowsanatomicreduction.Thepatientshowedaminimalincision.儿童桡骨颈骨折治疗Postoperativeradiographshows23ThankYou儿童桡骨颈骨折治疗ThankYou儿童桡骨颈骨折治疗24ThankYou儿童桡骨颈骨折治疗ThankYou儿童桡骨颈骨折治疗25ThankYou儿童桡骨颈骨折治疗ThankYou儿童桡骨颈骨折治疗26AnatomyByfouryearsofage,theradialheadandneckhaveassumedtheiradultshapewithaphysiologicalangulationoftheneckintheanteroposterior(AP)planeofanaverageof12.5°laterallyandinthelateralplaneofanaverageof3.5°anteriorly.Theproximalradialepiphysisismainlysuppliedbyperiostealbloodvesselsrunningfromdistaltoproximal.儿童桡骨颈骨折治疗AnatomyByfouryearsofage,27Mechanism’2mainmechanismsofinjuryweredescribedinliterature.Inthemorecommontype,aradialneckfractureoccursafterafallwiththeelbowinextensionandvalgus,resultinginafracturewithvalgusangulation.Intheraretype,themechanismisafallwiththeelbowflexed,whichcausestemporaryandposteriordislocationoftheelbowjoint.儿童桡骨颈骨折治疗Mechanism’2mainmechanismso28Treatment’Thereisstillsomecontroversyaboutmanagementofradialneckfracturesinchildren.Acceptabledegreesofangulationrangefrom15to45degrees.Weagreewiththemajoritywhorecommendtreatingfractureswithanangulationoflessthan30degreeswithimmobilizationaloneandthosewithmorethan30degreesangulationbymeansofsurgery.儿童桡骨颈骨折治疗Treatment’Thereisstillsome29Reduction’Theseverelyangulatedfracturescanbetreatedwithclosedreduction,percutaneousreduction,andopenReduction.儿童桡骨颈骨折治疗Reduction’Theseverelyangula30Openreduction’openreductioniscontroversial.Traditionally,itwasperformedifclosedmanipulationfailed.ingeneral,outcomesafteropenreductionareworsethanthoseobtainedafterclosedreduction.afteropenreduction,theincidenceofcomplication,ishigherthanthoseafterclosedreduction.openreductioncausesadditionaldamagetothesofttissue,withfibrousadhesionsandlossofrangeofmotion.Someradialneckfracturesareimpossibletoreducewithclosedmethods,requiringopenreduction儿童桡骨颈骨折治疗Openreduction’openreduction31AdvantageofES