桡骨小头骨折切开内固定术

PreoperativeAPradiographofaType2radialheadfracture.PreoperativelateralradiographofaType2radialheadfracture.PreoperativelateralradiographoftheType2radialheadfracture.Theelbowisflexedandpositionedonaradiolucenttable.Theincisionbeginsjustabovethelateralepicondyleandextendsdowntowardstheulna,passingdirectlyovertheradialhead,asdepicted.Theskinincisionisbroughtdownthroughthesubcutaneoustissueandthecommonextensororiginisidentified.Thecommonextensororiginisincisedbetweentheanconeusandtheextensorcarpiulnarisoverthecapitellumradialhead.ANCONEUSECUTheupperedgeofthecapitellumandtheradialheadareexposed.RADIALHEADWithsharpretractionandrotationoftheradialhead,thefractureisidentified.Caremustbetakennottoextendthisincisiontoofardistally,asthismaydamagetotheposteriorinterosseousnerve,asitlayovertheradialneck.ANNULARLIGAMENTRADIALHEADFRACTUREAFreerelevatororsmallosteotomeisintroducedtomobilizetheradialheadfracture.CloseupviewCAPITELLUMRADIALHEADAfteranatomicreductionisachieved,K-wiresareusedtomaintainthereduction.K-WIREREDUCTIONAfteranatomicreductionisachieved,K-wiresareusedtomaintainthereduction.K-WIREREDUCTIONUsingtheexternaljig,ascrewisplacedsuchthatitiscountersunkbelowthearticularsurfaceoftheradialhead.Inthisexample,asolidHerbertscrewisutilized.Thereducedandfixedradialhead.TheHerbertscrewseatedunderthearticularsurface.Occasionally,thesecondK-wireisexchangedforaHerbertscrew.FRACTUREHERBERTSCREWTherangeofmotionoftheforearmaswellaspronationandsupinationareconfirmed,andthereductionisvisualizedthroughoutinarcofmotionoftheelbow.Ifadequatelyfixedandstable,closureisperformed.FRACTUREHERBERTSCREWThecommonextensormechanismisbroughttogether,enclosedovertheradio-capitellarjoint.Afterclosure.Lateralview,demonstratingthereduction