儿童桡骨颈骨折治疗课件.ppt

Radial Neck Fracturesin Children Treated With ElasticStable Intramedullary Nailing,Ningbo No. 6 hospital Caojin,儿童桡骨颈骨折治疗,Radial Neck Fracturesin Child,Anatomy,儿童桡骨颈骨折治疗,Anatomy 儿童桡骨颈骨折治疗,Characteristic,begins at four years and it fuses at the age of 14 in females and 17 in males.,Ossification center,儿童桡骨颈骨折治疗,Characteristicbegins at four y,Characteristic,age 414yearsdisease rate: 5% of elbow injuriesor 1% of all injuries in chindren,儿童桡骨颈骨折治疗,Characteristic age 414year,Mechanism,Elbow in extension :more common typeElbow in flexed:rare type,儿童桡骨颈骨折治疗,Mechanism Elbow in extension :,Classification,Judet,儿童桡骨颈骨折治疗,Classification Judet 儿童桡骨颈骨折治,D,Wilkins,E,儿童桡骨颈骨折治疗,DWilkins E儿童桡骨颈骨折治疗,Diagnosis,historysymptomphysical signradiograph,儿童桡骨颈骨折治疗,Diagnosis history儿童桡骨颈骨折治疗,Treatment,controversyacceptable degrees 1545the majority opinion 30,儿童桡骨颈骨折治疗,Treatment controversy儿童桡骨颈骨折治疗,Reduction,Closed reductionPercutaneous pin reductionOpen recuction,儿童桡骨颈骨折治疗,Reduction Closed reduction儿童桡骨,Closed reduction,30 6060,儿童桡骨颈骨折治疗,Closed reduction儿童桡骨颈骨折治疗,Percutaneous pin reduction,Risk :radial nerve injury,儿童桡骨颈骨折治疗,Percutaneous pin reductionRisk,Open reduction,controversialoutcomesincidence of complicationcauses additional damageopen reduction,儿童桡骨颈骨折治疗,Open reductioncontroversial儿童桡,Fixation,K-wires,Elastic nailing,儿童桡骨颈骨折治疗,Fixation K-wiresElastic n,Tecnique of elastic nailing,儿童桡骨颈骨折治疗,Tecnique of elastic nailing儿童桡,儿童桡骨颈骨折治疗,儿童桡骨颈骨折治疗,Postoperative radiograph,儿童桡骨颈骨折治疗,Postoperative radiograph儿童桡骨颈骨,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.,儿童桡骨颈骨折治疗,Case 1A 6-year-old boy sustain,Case 1,Follow-up radiograph shows fracture union and anatomic reduction.The patient showed an excellent clinical result and resumed full motion.,儿童桡骨颈骨折治疗,Case 1Follow-up radiograph sho,Complication,Infectionelbow stiffnessavascular necrosispremature physeal closure,儿童桡骨颈骨折治疗,Complication Infection儿童桡骨颈骨折治,Advantage of ESIN,minimally invasive techniquestable fixationearly mobilizationanatomical reductionlower complication rategood-to-excellent results,儿童桡骨颈骨折治疗,Advantage of ESINminimally inv,Case 2,10-year-old boy sustained a Judet type IV fracture of the radial neck.,儿童桡骨颈骨折治疗,Case 2 10-year-old boy sustain,Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.,儿童桡骨颈骨折治疗,Postoperative radiograph shows,Thank You,儿童桡骨颈骨折治疗,Thank You儿童桡骨颈骨折治疗,Thank You,儿童桡骨颈骨折治疗,Thank You儿童桡骨颈骨折治疗,Thank You,儿童桡骨颈骨折治疗,Thank You儿童桡骨颈骨折治疗,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.,儿童桡骨颈骨折治疗,Anatomy By four years of age,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.,儿童桡骨颈骨折治疗,Mechanism 2 main mechanisms o,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.,儿童桡骨颈骨折治疗,Treatment There is still some,Reduction,The severely angulated fractures can be treated with closed reduction, percutaneous reduction, and open Reduction.,儿童桡骨颈骨折治疗,Reduction The severely angula,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,儿童桡骨颈骨折治疗,Open reductionopen 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.,儿童桡骨颈骨折治疗,Advantage of ESINESIN is a min,