兒童橈骨頸骨折治療課件

RadialNeckFractures

inChildrenTreatedWithElastic

StableIntramedullaryNailingNingboNo.6hospital

Caojin1RadialNeckFractures

inChildAnatomy2Anatomy2Characteristicbeginsatfouryearsanditfusesattheageof14infemalesand17inmales.Ossificationcenter3CharacteristicbeginsatfouryCharacteristicage

4～14yearsdiseaserate:5%ofelbowinjuriesor1%ofallinjuriesinchindren

4Characteristicage4～14yearMechanismElbowinextension:morecommontypeElbowinflexed:raretype5MechanismElbowinextension:ClassificationJudet6ClassificationJudet6DWilkins

E7DWilkinsE7Diagnosishistorysymptomphysicalsignradiograph8Diagnosishistory8Treatmentcontroversyacceptabledegrees15°~45°themajorityopinion30°9Treatmentcontroversy9ReductionClosedreductionPercutaneouspinreductionOpenrecuction10ReductionClosedreduction10Closedreduction30°～60°＞60°11Closedreduction11PercutaneouspinreductionRisk:radialnerveinjury12PercutaneouspinreductionRiskOpenreductioncontroversialoutcomesincidenceofcomplicationcausesadditionaldamageopenreduction13Openreductioncontroversial13FixationK-wiresElasticnailing14FixationK-wiresElasticnTecniqueofelasticnailing15Tecniqueofelasticnailing151616Postoperativeradiograph17Postoperativeradiograph17Case1A6-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Follow-upradiographafterelasticnailingshowsgoodreduction.Thepatienthadanexcellentoutcome.18Case1A6-year-oldboysustainCase1Follow-upradiographshowsfractureunionandanatomicreduction.Thepatientshowedanexcellentclinicalresultandresumedfullmotion.19Case1Follow-upradiographshoComplicationInfectionelbowstiffnessavascularnecrosisprematurephysealclosure20ComplicationInfection20AdvantageofESINminimallyinvasivetechniquestablefixationearlymobilizationanatomicalreductionlowercomplicationrategood-to-excellentresults21AdvantageofESINminimallyinvCase210-year-oldboysustainedaJudettypeIVfractureoftheradialneck.22Case210-year-oldboysustainPostoperativeradiographshowsanatomicreduction.Thepatientshowedaminimalincision.23PostoperativeradiographshowsThankYou24ThankYou24ThankYou25ThankYou25ThankYou26ThankYou26AnatomyByfouryearsofage,theradialheadandneckhaveassumedtheiradultshapewithaphysiologicalangulationoftheneckintheanteroposterior(AP)planeofanaverageof12.5°laterallyandinthelateralplaneofanaverageof3.5°anteriorly.Theproximalradialepiphysisismainlysuppliedbyperiostealbloodvesselsrunningfromdistaltoproximal.27AnatomyByfouryearsofage,Mechanism’2mainmechanismsofinjuryweredescribedinliterature.Inthemorecommontype,aradialneckfractureoccursafterafallwiththeelbowinextensionandvalgus,resultinginafracturewithvalgusangulation.Intheraretype,themechanismisafallwiththeelbowflexed,whichcausestemporaryandposteriordislocationoftheelbowjoint.28Mechanism’2mainmechanismsoTreatment’Thereisstillsomecontroversyaboutmanagementofradialneckfracturesinchildren.Acceptabledegreesofangulationrangefrom15to45degrees.Weagreewiththemajoritywhorecommendtreatingfractureswithanangulationoflessthan30degreeswithimmobilizationaloneandthosewithmorethan30degreesangulationbymeansofsurgery.29Treatment’ThereisstillsomeReduction’Theseverelyangulatedfracturescanbetreatedwithclosedreduction,percutaneousreduction,andopenReduction.30Reduction’TheseverelyangulaOpenreduction’openreductioniscontroversial.Traditionally,itwasperformedifclosedmanipulationfailed.ingeneral,outcomesafteropenreductionareworsethanthoseobtainedafterclosedreduction.afteropenreduction,theincidenceofcomplication,ishigherthanthoseafterclosedreduction.openreductioncausesadditionaldamagetothesofttissue,withfibrousadhesionsandlossofrangeofmotion.Someradialneckfracturesareimpossibletoreducewithclosedmethods,requiringopenreduction31Openreduction’openreduction結(jié)束語(yǔ)當(dāng)你盡了自己的最大努力時(shí)，失敗也是偉大的，