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RadialNeckFracturesinChildrenTreatedWithElasticStableIntramedullaryNailingNingboNo.6hospitalCaojin儿童桡骨颈骨折治疗Anatom

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

•diseaserate:5%ofelbowinjuriesor1%ofallinjuriesinchindren儿童桡骨颈骨折治疗MechanismElbowinextension:morecommontypeElbowinflexed:raretype儿童桡骨颈骨折治疗Classif

icationJudet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⚫acceptablede

grees15°~45°⚫themajorityopinion30°儿童桡骨颈骨折治疗Reduction❖Closedreduction❖Percutaneouspinreduction❖Openrecuction儿童桡骨颈骨折治疗Closedreducti

on30°～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-upradio

graphafterelasticnailingshowsgoodreduction.Thepatienthadanexcellentoutcome.儿童桡骨颈骨折治疗Case1•Follow-upradiograph

showsfractureunionandanatomicreduction.Thepatientshowedanexcellentclinicalresultandresumedfullmotion.儿童桡

骨颈骨折治疗Complication◼Infection◼elbowstiffness◼avascularnecrosis◼prematurephysealclosure儿童桡骨颈骨折治疗AdvantageofESIN◼minimallyinvasivetec

hnique◼stablefixation◼earlymobilization◼anatomicalreduction◼lowercomplicationrate◼good-to-excellentresults儿童桡骨

颈骨折治疗Case2•10-year-oldboysustainedaJudettypeIVfractureoftheradialneck.儿童桡骨颈骨折治疗•Postoperativeradiographshowsanatomicre

duction.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,theradialheadandneckhav

eassumedtheiradultshapewithaphysiologicalangulationoftheneckintheanteroposterior(AP)planeofanaverageof12.5°late

rallyandinthelateralplaneofanaverageof3.5°anteriorly.•Theproximalradialepiphysisismainlysuppliedbyperiostealbloodvesselsrunningfromdistaltoproxi

mal.儿童桡骨颈骨折治疗Mechanism’•2mainmechanismsofinjuryweredescribedinliterature.•Inthemorecommontype,aradialneckfractureoccursafte

rafallwiththeelbowinextensionandvalgus,resultinginafracturewithvalgusangulation.•Intheraretype,themechanismisafallwitht

heelbowflexed,whichcausestemporaryandposteriordislocationoftheelbowjoint.儿童桡骨颈骨折治疗Treatment’⚫Thereisstillsomec

ontroversyaboutmanagementofradialneckfracturesinchildren.⚫Acceptabledegreesofangulationrangefrom15to45degrees.⚫

Weagreewiththemajoritywhorecommendtreatingfractureswithanangulationoflessthan30degreeswithimmobilizationaloneand

thosewithmorethan30degreesangulationbymeansofsurgery.儿童桡骨颈骨折治疗Reduction’❖Theseverelyangulatedfracturescanbetreatedwithclosedreduction,percutaneousred

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

failed.•ingeneral,outcomesafteropenreductionareworsethanthoseobtainedafterclosedreduction.•afteropenreduction,theincidenceofcom

plication,ishigherthanthoseafterclosedreduction.•openreductioncausesadditionaldamagetothesofttissue,withfibrousadhes

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

INisaminimallyinvasivetechnique,allowingstablefixation,earlymobilization,andanatomicalreductioninmostcases.◼Thecomplica

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