儿童桡骨颈骨折治疗PPT课件
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• begins at four years and it fuses at the age of 14 in females and 17 in males.
a
3
Characteristic
• age 4～14years
• disease rate: 5% of elbow injuries
or 1% of all injuries in chindren
• The proximal radial epiphysis is mainly supplied by periosteal blood vessels running from distal to proximal.
a
பைடு நூலகம்
27
Mechanism’
• 2 main mechanisms of injury were described in literature.
a
21
Case 2
• 10-year-old boy sustained a Judet type IV fracture of the radial neck.
a
22
• Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.
18
Case 1
• Follow-up radiograph shows fracture union and anatomic
reduction.The patient showed an excellent clinical result and
a
19
resumed full motion.
Complication
• 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.
a
17
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 haad an excellent outcome.
a
23
a
24
a
25
a
26
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.
a
8
Treatment
controversy
acceptable degrees
15°~45°
the majority opinion
30°
a
9
Reduction
❖ Closed reduction ❖ Percutaneous pin reduction ❖ Open recuction
a
10
Closed reduction
30 ° ～60° ＞60°
a
11
Percutaneous pin reduction
• Risk :radial nerve injury
a
12
Open reduction
• controversial • outcomes • incidence of
Radial Neck Fractures in Children Treated With Elastic Stable Intramedullary Nailing
Ningbo No. 6 hospital
Caojin
a
1
Anatomy
a
2
Characteristic
Ossification center
complication • causes additional
damage • open reduction
a
13
K-wires
Fixation
Elastic nailing
a
14
Tecnique of elastic nailing
a
15
a
16
Postoperative radiograph
• In the rare type, the mechanism is a fall with the elbow flexed, which causes temporary and posterior dislocation of the elbow joint.
a
28
Treatment’
There is still some controversy about management of radial neck fractures in children.
a
4
Mechanism
Elbow in extension :more common type
Elbow in flexed:rare type
a
5
Judet
Classification
a
6
• Wilkins
a
D
E
7
Diagnosis
• history • symptom • physical sign • radiograph
Infection elbow stiffness avascular necrosis premature physeal closure
a
20
Advantage of ESIN
minimally invasive technique stable fixation early mobilization anatomical reduction lower complication rate good-to-excellent results
a
3
Characteristic
• age 4～14years
• disease rate: 5% of elbow injuries
or 1% of all injuries in chindren
• The proximal radial epiphysis is mainly supplied by periosteal blood vessels running from distal to proximal.
a
பைடு நூலகம்
27
Mechanism’
• 2 main mechanisms of injury were described in literature.
a
21
Case 2
• 10-year-old boy sustained a Judet type IV fracture of the radial neck.
a
22
• Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.
18
Case 1
• Follow-up radiograph shows fracture union and anatomic
reduction.The patient showed an excellent clinical result and
a
19
resumed full motion.
Complication
• 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.
a
17
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 haad an excellent outcome.
a
23
a
24
a
25
a
26
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.
a
8
Treatment
controversy
acceptable degrees
15°~45°
the majority opinion
30°
a
9
Reduction
❖ Closed reduction ❖ Percutaneous pin reduction ❖ Open recuction
a
10
Closed reduction
30 ° ～60° ＞60°
a
11
Percutaneous pin reduction
• Risk :radial nerve injury
a
12
Open reduction
• controversial • outcomes • incidence of
Radial Neck Fractures in Children Treated With Elastic Stable Intramedullary Nailing
Ningbo No. 6 hospital
Caojin
a
1
Anatomy
a
2
Characteristic
Ossification center
complication • causes additional
damage • open reduction
a
13
K-wires
Fixation
Elastic nailing
a
14
Tecnique of elastic nailing
a
15
a
16
Postoperative radiograph
• In the rare type, the mechanism is a fall with the elbow flexed, which causes temporary and posterior dislocation of the elbow joint.
a
28
Treatment’
There is still some controversy about management of radial neck fractures in children.
a
4
Mechanism
Elbow in extension :more common type
Elbow in flexed:rare type
a
5
Judet
Classification
a
6
• Wilkins
a
D
E
7
Diagnosis
• history • symptom • physical sign • radiograph
Infection elbow stiffness avascular necrosis premature physeal closure
a
20
Advantage of ESIN
minimally invasive technique stable fixation early mobilization anatomical reduction lower complication rate good-to-excellent results