儿童肱骨近端骨折

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1、儿童肱骨近端骨折proximalhumerusfractureinchildrenElasticStableIntramedullaryNails弹性髓内钉广西中医药大学第三附属医院（柳州）王小芃Vascularanatomyoftheproximalhumerus.1Axillaryartery.2Posteriorhumeralcircumflexartery.3Anteriorhumeralcircumflexartery.4Lateralascendingbranchoftheanteriorhumeralcircumflexa

2、rtery.5Greatertuberosity.6Lessertuberosity.7Tendoninsertionoftheinfraspinatusmuscle.8Tendoninsertionoftheteresminormuscle.Whenisreduction(non-operativeandoperative)required?Theproximalphysiscontributes80%ofthelengthofthehumerus. Duetotheenormousremodellingpotential,mosto

3、ftheseinjuriesdonotrequirereduction. ThereisnoroleforattemptedreductionintheED.Theolderchildwithgreaterdeformitymaybetreatedwithclosedreduction. Thisiscontroversialandtherearenoagreedfigurestoguideclosedoperativereduction.Approximateindicationsare:5-12years-accept60degreeang

4、ulationand50%displacement>12years-accept30degreesangulationand30%displacementIsolatedgreatertuberosityfractureswithdisplacementintheadolescentareanexceptiongroupinwhichsurgicalreductionandfixationisusuallyrequired.DoIneedtorefertoorthopaedicsnow?Indicationsforpromptreferralt

5、otheorthopaediconcallserviceinclude:>50%displacementofthehumeralheadrelativetotheshaftAngulationontheAPorlateralx-rayof>60degreesinachild<12yearsold,or>30degreesinachild>12yearsPathologicalfractureoftheproximalhumerusAssociatedinjuries,i.e.brachialplexusinjury,vascularinjury

6、InassociationwithotherunilateralupperlimbfracturesMultitraumaElasticStableIntramedullaryNailsMorerecentlyproposedformoffixationAvoidmorbidityofpercutaneouspinsSofttissueirritationMigrationRequiresrepeatanestheticforremovalESINTIPS&TECHNIQUESOrthopedicsOctober2012-Volume35·I

7、ssue10:856-860CentromedullaryManipulationandStabilizationofCompletelyDisplacedProximalHumerusFracturesinAdolescents。青少年肱骨近端完全移位骨折髓内操作和稳定。Figure1:Anteroposteriorradiographoftheshouldershowingthedisplacedfracture(A)andYviewradiographoftheproximalhumerusshowing100%anteriortrans

8、lationofthehumeralshaft(B).Figure2:Illustrationofapatientpositionedsupineo