儿童桡骨颈骨折治疗

RadialNeckFracturesinChildrenTreatedWithElasticStableIntramedullaryNailingNingboNo.6hospitalCaojinAnatomyCharacteristic•beginsatfouryearsanditfusesattheageof14infemalesand17inmales.OssificationcenterCharacteristic•age4～14years•diseaserate:5%ofelbowinjuriesor1%ofallinjuriesinchindrenMechanismElbowinextension:morecommontypeElbowinflexed:raretypeClassificationJudetD•WilkinsEDiagnosis•history•symptom•physicalsign•radiographTreatmentcontroversyacceptabledegrees15°~45°themajorityopinion30°ReductionClosedreductionPercutaneouspinreductionOpenrecuctionClosedreduction30°～60°＞60°Percutaneouspinreduction•Risk:radialnerveinjuryOpenreduction•controversial•outcomes•incidenceofcomplication•causesadditionaldamage•openreductionFixationK-wiresElasticnailingTecniqueofelasticnailingPostoperativeradiographCase1•A6-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Follow-upradiographafterelasticnailingshowsgoodreduction.Thepatienthadanexcellentoutcome.Case1•Follow-upradiographshowsfractureunionandanatomicreduction.Thepatientshowedanexcellentclinicalresultandresumedfullmotion.ComplicationInfectionelbowstiffnessavascularnecrosisprematurephysealclosureAdvantageofESINminimallyinvasivetechniquestablefixationearlymobilizationanatomicalreductionlowercomplicationrategood-to-excellentresultsCase2•10-year-oldboysustainedaJudettypeIVfractureoftheradialneck.•Postoperativeradiographshowsanatomicreduction.Thepatientshowedaminimalincision.Anatomy•Byfouryearsofage,theradialheadandneckhaveassumedtheiradultshapewithaphysiologicalangulationoftheneckintheanteroposterior(AP)planeofanaverageof12.5°laterallyandinthelateralplaneofanaverageof3.5°anteriorly.•Theproximalradialepiphysisismainlysuppliedbyperiostealbloodvesselsrunningfromdistaltoproximal.Mechanism’•2mainmechanismsofinjuryweredescribedinliterature.•Inthemorecommontype,aradialneckfractureoccursafterafallwiththeelbowinextensionandvalgus,resultinginafracturewithvalgusangulation.•Intheraretype,themechanismisafallwiththeelbowflexed,whichcausestemporaryandposteriordislocationoftheelbowjoint.Treatment’Thereisstillsomecontroversyaboutmanagementofradialneckfracturesinchildren.Acceptabledegreesofangulationrangefrom15to45degrees.Weagreewiththemajoritywhorecommendtreatingfractureswithanangulationoflessthan30degreeswithimmobilizationaloneandthosewithmorethan30degreesangulationbymeansofsurgery.Reduction’Theseverelyangulatedfracturescanbetreatedwithclosedreduction,percutaneousreduction,andopenReduction.Openreduction’•openreductioniscontroversial.Traditionally,itwasperformedifclosedmanipulationfailed.•ingeneral,outcomesafteropenreductionareworsethanthoseobtainedafterclosedreduction.•afteropenreduction,theincidenceofcomplication,ishigherthanthoseafterclosedreduction.•openreductioncausesadditionaldamagetothesofttissue,withfibrousadhesionsandlossofrangeofmotion.•Someradialneckfracturesareimpossibletoreducewithclosedmethods,requiringopenreductionAdvantageofESINESINisaminimallyinvasivetechnique,allowingstablefixation,earlymobilization,andanatomicalreductioninmostcases.Thecomplicationrateislowandgood-to-excellentresultscanbeexpected.