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RadialNeckFractures

inChildrenTreatedWithElastic

StableIntramedullaryNailingNingboNo.6hospital

CaojinRadialNeckFractures

inChild1AnatomyAnatomy2Characteristicbeginsatfouryearsanditfusesattheageof14infemalesand17inmales.OssificationcenterCharacteristicbeginsatfoury3Characteristicage

4～14yearsdiseaserate:5%ofelbowinjuriesor1%ofallinjuriesinchindren

Characteristicage4～14year4MechanismElbowinextension:morecommontypeElbowinflexed:raretypeMechanismElbowinextension:5ClassificationJudetClassificationJudet6DWilkins

EDWilkinsE7DiagnosishistorysymptomphysicalsignradiographDiagnosishistory8Treatmentcontroversyacceptabledegrees15°~45°themajorityopinion30°Treatmentcontroversy9ReductionClosedreductionPercutaneouspinreductionOpenrecuctionReductionClosedreduction10Closedreduction30°～60°＞60°Closedreduction11PercutaneouspinreductionRisk:radialnerveinjuryPercutaneouspinreductionRisk12OpenreductioncontroversialoutcomesincidenceofcomplicationcausesadditionaldamageopenreductionOpenreductioncontroversial13FixationK-wiresElasticnailingFixationK-wiresElasticn14TecniqueofelasticnailingTecniqueofelasticnailing15兒童橈骨頸骨折治療課件16PostoperativeradiographPostoperativeradiograph17Case1A6-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Follow-upradiographafterelasticnailingshowsgoodreduction.Thepatienthadanexcellentoutcome.Case1A6-year-oldboysustain18Case1Follow-upradiographshowsfractureunionandanatomicreduction.Thepatientshowedanexcellentclinicalresultandresumedfullmotion.Case1Follow-upradiographsho19ComplicationInfectionelbowstiffnessavascularnecrosisprematurephysealclosureComplicationInfection20AdvantageofESINminimallyinvasivetechniquestablefixationearlymobilizationanatomicalreductionlowercomplicationrategood-to-excellentresultsAdvantageofESINminimallyinv21Case210-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Case210-year-oldboysustain22Postoperativeradiographshowsanatomicreduction.Thepatientshowedaminimalincision.Postoperativeradiographshows23ThankYouThankYou24ThankYouThankYou25ThankYouThankYou26AnatomyByfouryearsofage,theradialheadandneckhaveassumedtheiradultshapewithaphysiologicalangulationoftheneckintheanteroposterior(AP)planeofanaverageof12.5°laterallyandinthelateralplaneofanaverageof3.5°anteriorly.Theproximalradialepiphysisismainlysuppliedbyperiostealbloodvesselsrunningfromdistaltoproximal.AnatomyByfouryearsofage,27Mechanism’2mainmechanismsofinjuryweredescribedinliterature.Inthemorecommontype,aradialneckfractureoccursafterafallwiththeelbowinextensionandvalgus,resultinginafracturewithvalgusangulation.Intheraretype,themechanismisafallwiththeelbowflexed,whichcausestemporaryandposteriordislocationoftheelbowjoint.Mechanism’2mainmechanismso28Treatment’Thereisstillsomecontroversyaboutmanagementofradialneckfracturesinchildren.Acceptabledegreesofangulationrangefrom15to45degrees.Weagreewiththemajoritywhorecommendtreatingfractureswithanangulationoflessthan30degreeswithimmobilizationaloneandthosewithmorethan30degreesangulationbymeansofsurgery.Treatment’Thereisstillsome29Reduction’Theseverelyangulatedfracturescanbetreatedwithclosedreduction,percutaneousreduction,andopenReduction.Reduction’Theseverelyangula30Openreduction’openreductioniscontroversial.Traditionally,itwasperformedifclosedmanipulationfailed.ingeneral,outcomesafteropenreductionareworsethanthoseobtainedafterclosedreduction.afteropenreduction,theincidenceofcomplication,ishigherthanthoseafterclosedreduction.openreductioncausesadditionaldamagetothesofttissue,withfibrousadhesionsandlossofrangeofmotion.Someradialneckfracturesareimpossibletoreducewithclosedmethods,requiringopenreductionOpenreduction’openreduction31AdvantageofESINESINisaminimallyinvasivetechnique,allowingstablefixation,earlymobilization,andanatomicalreductioninmostcases.Thecomplicationrateislowandgood-to-excellentresultscanbeexpected.AdvantageofESINESINisamin32RadialNeckFractures

inChildrenTreatedWithElastic

StableIntramedullaryNailingNingboNo.6hospital

CaojinRadialNeckFractures

inChild33AnatomyAnatomy34Characteristicbeginsatfouryearsanditfusesattheageof14infemalesand17inmales.OssificationcenterCharacteristicbeginsatfoury35Characteristicage

4～14yearsdiseaserate:5%ofelbowinjuriesor1%ofallinjuriesinchindren

Characteristicage4～14year36MechanismElbowinextension:morecommontypeElbowinflexed:raretypeMechanismElbowinextension:37ClassificationJudetClassificationJudet38DWilkins

EDWilkinsE39DiagnosishistorysymptomphysicalsignradiographDiagnosishistory40Treatmentcontroversyacceptabledegrees15°~45°themajorityopinion30°Treatmentcontroversy41ReductionClosedreductionPercutaneouspinreductionOpenrecuctionReductionClosedreduction42Closedreduction30°～60°＞60°Closedreduction43PercutaneouspinreductionRisk:radialnerveinjuryPercutaneouspinreductionRisk44OpenreductioncontroversialoutcomesincidenceofcomplicationcausesadditionaldamageopenreductionOpenreductioncontroversial45FixationK-wiresElasticnailingFixationK-wiresElasticn46TecniqueofelasticnailingTecniqueofelasticnailing47兒童橈骨頸骨折治療課件48PostoperativeradiographPostoperativeradiograph49Case1A6-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Follow-upradiographafterelasticnailingshowsgoodreduction.Thepatienthadanexcellentoutcome.Case1A6-year-oldboysustain50Case1Follow-upradiographshowsfractureunionandanatomicreduction.Thepatientshowedanexcellentclinicalresultandresumedfullmotion.Case1Follow-upradiographsho51ComplicationInfectionelbowstiffnessavascularnecrosisprematurephysealclosureComplicationInfection52AdvantageofESINminimallyinvasivetechniquestablefixationearlymobilizationanatomicalreductionlowercomplicationrategood-to-excellentresultsAdvantageofESINminimallyinv53Case210-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Case210-year-oldboysustain54Postoperativeradiographshowsanatomicreduction.Thepatientshowedaminimalincision.Postoperativeradiographshows55ThankYouThankYou56ThankYouThankYou57ThankYouThankYou58AnatomyByfouryearsofage,theradialheadandneckhaveassumedtheiradultshapewithaphysiologicalangulationoftheneckintheanteroposterior(AP)planeofanaverageof12.5°laterallyandinthelateralplaneofanaverageof3.5°anteriorly.Theproximalradialepiphysisismainlysuppliedbyperiostealbloodvesselsrunningfromdistaltoproximal.AnatomyByfouryearsofage,59Mechanism’2mainmechanismsofinjuryweredescribedinliterature.Inthemorecommontype,aradialneckfractureoccursafterafallwiththeelbowinextensionandvalgus,resultinginafracturewithvalgusangulation.Intheraretype,themechanismisafallwiththeelbowflexed,whichcausestemporaryandposteriordislocationoftheelbowjoint.Mechanism’2mainmechanismso60Treatment’Thereisstillsomecontroversyaboutmanagementofradialneckfracturesinchildren.Acceptabledegreesofangulationrangefrom15to45degrees.Weagreewiththemajoritywhorecommendtreatingfractureswithanangulationoflessthan30degreeswithimmobilizationaloneandthosewithmorethan30degreesangulationbymeansofsurgery.Treatment’Thereisstillsome61Reduction’Theseverelyangulatedfracturescanbe

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