兒童橈骨頸骨折治療

1、Radial Neck Fracturesin Children Treated With ElasticStable Intramedullary Nailing,Ningbo No. 6 hospital Caojin,Anatomy,,,Characteristic,begins at four years and it fuses at the age of 14 in females and

2、17 in males.,Ossification center,Characteristic,age 4～14yearsdisease rate: 5% of elbow injuriesor 1% of all injuries in chindren,Mechanism,Elbow in extension :more common typeElbow in flexed:rare type,,Classifica

3、tion,Judet,D,Wilkins,E,Diagnosis,historysymptomphysical signradiograph,Treatment,controversyacceptable degrees 15°~45°the majority opinion 30°,,Reduction,Closed reduction

4、Percutaneous pin reductionOpen recuction,,Closed reduction,30 ° ～60°＞60°,Percutaneous pin reduction,Risk :radial nerve injury,Open reduction,controversialoutcomesincidence of complicationcauses add

5、itional damageopen reduction,,Fixation,K-wires,Elastic nailing,Tecnique of elastic nailing,,Postoperative radiograph,Case 1,A 6-year-old boy sustained a Judet type IV fracture of the radial neck. Follow-up radiograph af

6、ter elastic nailing shows good reduction.The patient had an excellent outcome.,,,,,Case 1,,Follow-up radiograph shows fracture union and anatomic reduction.The patient showed an excellent clinical result and resumed full

7、 motion.,Complication,Infectionelbow stiffnessavascular necrosispremature physeal closure,Advantage of ESIN,minimally invasive techniquestable fixationearly mobilizationanatomical reductionlower complication rate

8、good-to-excellent results,,Case 2,10-year-old boy sustained a Judet type IV fracture of the radial neck.,,,,Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.,,,,Thank You,,,Thank Yo

9、u,,,Thank You,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

10、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.,,Mechanism’,2 main mechanisms of injury were desc

11、ribed 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 w

12、ith the elbow flexed, which causes temporary and posterior dislocation of the elbow joint.,,Treatment’,There is still some controversy about management of radial neck fractures in children. Acceptable degrees of angulat

13、ion 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

14、 surgery.,,Reduction’,The severely angulated fractures can be treated with closed reduction, percutaneous reduction, and open Reduction.,,Open reduction’,open reduction is controversial.Traditionally, it was performed if

15、 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 reducti

16、on.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,,Advan