儿童桡骨颈骨折治疗课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Radial Neck Fracturesin Children Treated With ElasticStable Intramedullary Nailing,Ningbo No.6 hospital,Caojin,Radial Neck Fracturesin Child,1,Anatomy,Anatomy,2,Characteristic,begins at four years and it fuses at the age of 14 in females and 17 in males.,Ossification center,Characteristicbegins at four y,3,Characteristic,age,4,14years,disease rate:,5%of elbow injuries,or 1%of all injuries in chindren,Characteristic age 414year,4,Mechanism,Elbow in extension:,more common type,Elbow in flexed:,rare type,Mechanism Elbow in extension:,5,Classification,Judet,Classification Judet,6,D,Wilkins,E,DWilkins E,7,Diagnosis,history,symptom,physical sign,radiograph,Diagnosis history,8,Treatment,controversy,acceptable degrees 1545,the majority opinion 30,Treatment controversy,9,Reduction,Closed reduction,Percutaneous pin reduction,Open recuction,Reduction Closed reduction,10,Closed reduction,30,60,60,Closed reduction,11,Percutaneous pin reduction,Risk:radial nerve injury,Percutaneous pin reductionRisk,12,Open reduction,controversial,outcomes,incidence of complication,causes additional damage,open reduction,Open reductioncontroversial,13,Fixation,K-wires,Elastic nailing,Fixation K-wiresElastic n,14,Tecnique of elastic nailing,Tecnique of elastic nailing,15,儿童桡骨颈骨折治疗课件,16,Postoperative radiograph,Postoperative radiograph,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 had an excellent outcome.,Case 1A 6-year-old boy sustain,18,Case 1,Follow-up radiograph shows fracture union and anatomic reduction.The patient showed an excellent clinical result and resumed full motion.,Case 1Follow-up radiograph sho,19,Complication,Infection,elbow stiffness,avascular necrosis,premature physeal closure,Complication Infection,20,Advantage of ESIN,minimally invasive technique,stable fixation,early mobilization,anatomical reduction,lower complication rate,good-to-excellent results,Advantage of ESINminimally inv,21,Case 2,10-year-old boy sustained a Judet type IV fracture of the radial neck.,Case 2 10-year-old boy sustain,22,Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.,Postoperative radiograph shows,23,Thank You,Thank You,24,Thank You,Thank You,25,Thank You,Thank You,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.,The proximal radial epiphysis is mainly supplied by periosteal blood vessels running from distal to proximal.,Anatomy By four years of age,27,Mechanism,2 main mechanisms of injury were described 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 with the elbow flexed,which causes temporary and posterior dislocation of the elbow joint.,Mechanism 2 main mechanisms o,28,Treatment,There is still some controversy about management of radial neck fractures in children.,Acceptable degrees of angulation 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 surgery.,Treatment There is still some,29,Reduction,The severely angulated fractures can be treated with closed reduction,percutaneous reduction,and open Reduction.,Reduction The severely angula,30,Open reduction,open reduction is controversial.Traditionally,it was performed if 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 reduction.,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 close