桡骨小头骨折切开内固定术 PPT

The elbow is flexed and positioned on a radiolucent table. The incision begins just above the lateral epicondyle and extends down towards the ulna, passing directly over the radial head, as depicted.
桡骨小头骨折切开内固定术
Preoperative AP radiograph of a Type 2 radial head fracture.
Preoperative lateral radiograph of a Type 2 radial head fracture.
Preoperative lateral radiograph of the Type 2 radial head fracture.
The skin incision is brought down through the subcutaneous tissue and the mon extensor origin is identified.
ECU ANCONEUS
The mon extensor origin is incised between the anconeus and the extensor carpi ulnaris over the capitellum radial head.
REDUCTION
K-WIRE
After anatomic reduction is achieved, K-wires are used to maintain the reduction.
Using the external jig, a screw is placed such that it is countersunk below the articular surface of the radial head. In this example, a solid Herbert screw is utilized.
A Freer elevator or small osteotome is introduced to mobilize the radial head fracture.
RADIAL HEAD
CAPITELLUM
Close up view
REDUCTION
K-WIRE
After anatomic reduction is achieved, K-wires are used to maintain the reduction.
FRACTURE
HERBERT SCREW
The range of motion of the forearm as well as pronation and supination are confirmed, and the reduction is visualized throughout in arc of motion of the elbow. If adequately fixed and stable, closure is performed.
The mon extensor mechanism is brought together, enclosed over the radio-capitellar joint.
After closure.
Lateral view, demonstrating the reduction
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The upper edge of the capitellum and the radial head are exposed.
RADIAL HEAD
ANNULAR LIGAMENT
RADIAL HEAD FRACTURE
With sharp retraction and rotation of the radial head, the fracture is identified. Care must be taken not to extend this incision too far distally, as this may damage to the posterior interosseous nerve, as it lay over the radial neck.
FRACTURE
HERBERT SCREW
The reduced and fixed radial head. The Herbert screw seated under the articular surface. Occasionally, the second K-wire is exchanged for a Herbert screw.