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