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RadialNeckFracturesinChildrenTreatedWithElasticStableIntramedullaryNailingNingboNo.6hospitalCaojin儿童桡骨颈

骨折治疗Anatomy儿童桡骨颈骨折治疗Characteristic•beginsatfouryearsanditfusesattheageof14infemalesand17inmales.Ossificationcenter儿童桡骨颈骨折治疗Characteristic•age4～14yea

rs•diseaserate:5%ofelbowinjuriesor1%ofallinjuriesinchindren儿童桡骨颈骨折治疗MechanismElbowinextension:morecommon

typeElbowinflexed:raretype儿童桡骨颈骨折治疗ClassificationJudet儿童桡骨颈骨折治疗D•WilkinsE儿童桡骨颈骨折治疗Diagnosis•history•symptom•physicalsign•radiograph儿童桡骨颈骨折治疗

Treatment⚫controversy⚫acceptabledegrees15°~45°⚫themajorityopinion30°儿童桡骨颈骨折治疗Reduction❖Closedreduction❖Percutaneouspinreduction❖O

penrecuction儿童桡骨颈骨折治疗Closedreduction30°～60°＞60°儿童桡骨颈骨折治疗Percutaneouspinreduction•Risk:radialnerveinjury儿童桡骨颈骨折治疗Openreduction•controversial•outcomes•

incidenceofcomplication•causesadditionaldamage•openreduction儿童桡骨颈骨折治疗FixationK-wiresElasticnailing儿童桡骨颈骨折治疗Tecniqueofelasticnailing儿童桡骨颈骨折治疗

儿童桡骨颈骨折治疗Postoperativeradiograph儿童桡骨颈骨折治疗Case1•A6-year-oldboysustainedaJudettypeIVfractureoftheradialneck.Follow-upradiographafterelasticnail

ingshowsgoodreduction.Thepatienthadanexcellentoutcome.儿童桡骨颈骨折治疗Case1•Follow-upradiographshowsfractureunionandanatomicreduction.Thepat

ientshowedanexcellentclinicalresultandresumedfullmotion.儿童桡骨颈骨折治疗Complication◼Infection◼elbowstiffness◼avascul

arnecrosis◼prematurephysealclosure儿童桡骨颈骨折治疗AdvantageofESIN◼minimallyinvasivetechnique◼stablefixation◼earlymobilizati

on◼anatomicalreduction◼lowercomplicationrate◼good-to-excellentresults儿童桡骨颈骨折治疗Case2•10-year-oldboysustainedaJudettypeI

Vfractureoftheradialneck.儿童桡骨颈骨折治疗•Postoperativeradiographshowsanatomicreduction.Thepatientshowedaminimalincision.儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗儿童桡骨颈骨折治疗儿

童桡骨颈骨折治疗Anatomy•Byfouryearsofage,theradialheadandneckhaveassumedtheiradultshapewithaphysiologicalangulationoftheneckintheanteropos

terior(AP)planeofanaverageof12.5°laterallyandinthelateralplaneofanaverageof3.5°anteriorly.•Theproximalradialepiphysisis

mainlysuppliedbyperiostealbloodvesselsrunningfromdistaltoproximal.儿童桡骨颈骨折治疗Mechanism’•2mainmechanismsofinjuryweredescribedinliterature.•I

nthemorecommontype,aradialneckfractureoccursafterafallwiththeelbowinextensionandvalgus,resultinginafracturewithvalgusangula

tion.•Intheraretype,themechanismisafallwiththeelbowflexed,whichcausestemporaryandposteriordislocationoftheelbowjoint.儿童桡骨颈骨折治疗Treatment’⚫There

isstillsomecontroversyaboutmanagementofradialneckfracturesinchildren.⚫Acceptabledegreesofangulationrangefrom15to45degrees.⚫W

eagreewiththemajoritywhorecommendtreatingfractureswithanangulationoflessthan30degreeswithimmobilizationaloneandthosewithmorethan30degreesan

gulationbymeansofsurgery.儿童桡骨颈骨折治疗Reduction’❖Theseverelyangulatedfracturescanbetreatedwithclosedreduction,percutaneousreductio

n,andopenReduction.儿童桡骨颈骨折治疗Openreduction’•openreductioniscontroversial.Traditionally,itwasperformedifclosedmanipulation

failed.•ingeneral,outcomesafteropenreductionareworsethanthoseobtainedafterclosedreduction.•afteropenreduction,theincidenceofcomplication,i

shigherthanthoseafterclosedreduction.•openreductioncausesadditionaldamagetothesofttissue,withfibrousadhesionsandlossofran

geofmotion.•Someradialneckfracturesareimpossibletoreducewithclosedmethods,requiringopenreduction儿童桡骨颈骨折治疗AdvantageofESIN◼ES

INisaminimallyinvasivetechnique,allowingstablefixation,earlymobilization,andanatomicalreductioninmostcases.◼Thec

omplicationrateislowandgood-to-excellentresultscanbeexpected.儿童桡骨颈骨折治疗