儿童桡骨颈骨折治疗ppt课件-PPT文档.ppt

Anatomy,Characteristic,begins at four years and it fuses at the age of 14 in females and 17 in males.,Ossification center,Characteristic,age 414years disease rate: 5% of elbow injuries or 1% of all injuries in chindren,Mechanism,Elbow in extension :more common type Elbow in flexed:rare type,Classification,Judet,D,Wilkins,E,Diagnosis,history symptom physical sign radiograph,Treatment,controversy acceptable degrees 15°45° the majority opinion 30°,Reduction,Closed reduction Percutaneous pin reduction Open recuction,Closed reduction,30 ° 60° 60°,Percutaneous pin reduction,Risk :radial nerve injury,Open reduction,controversial outcomes incidence of complication causes additional damage open reduction,Fixation,K-wires,Elastic nailing,Tecnique of elastic nailing,Postoperative radiograph,Case 1,A 6-year-old boy 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.,Case 1,Follow-up radiograph shows fracture union and anatomic reduction.The patient showed an excellent clinical result and resumed full motion.,Complication,Infection elbow stiffness avascular necrosis premature physeal closure,Advantage of ESIN,minimally invasive technique stable fixation early mobilization anatomical reduction lower complication rate good-to-excellent results,Case 2,10-year-old boy sustained a Judet type IV fracture of the radial neck.,Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.,Thank You,Thank You,Thank You,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 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 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, which causes temporary and posterior dislocation of the elbow joint.,Treatment,There is still some controversy about management of radial neck fractures 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 angulated 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, with fibrous adhesions and loss of range of motion. Some radial neck fractures are impossible to reduce with closed methods, requiring open reduction,Advantage of ESIN,ESIN is a minimally invasive technique, allowing stable fixation, early mobilization, and anatomical reduction in most cases. The complication rate is low and good-to-excellent results can be expected.,