儿童肱骨近端骨折ppt课件

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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.4Lateralascendingbranchoftheanteriorhume

2、ralcircumflexartery.5Greatertuberosity.6Lessertuberosity.7Tendoninsertionoftheinfraspinatusmuscle.8Tendoninsertionoftheteresminormuscle.Whenisreduction(non-operativeandoperative)required?Theproximalphysiscontributes80%ofthelengthofthehumerus. Duetotheenormo

3、usremodellingpotential,mostoftheseinjuriesdonotrequirereduction. ThereisnoroleforattemptedreductionintheED.Theolderchildwithgreaterdeformitymaybetreatedwithclosedreduction. Thisiscontroversialandtherearenoagreedfigurestoguideclosedoperativereduction.Approximate

4、indicationsare:5-12years-accept60degreeangulationand50%displacement>12years-accept30degreesangulationand30%displacementIsolatedgreatertuberosityfractureswithdisplacementintheadolescentareanexceptiongroupinwhichsurgicalreductionandfixationisusuallyrequired.DoIne

5、edtorefertoorthopaedicsnow?Indicationsforpromptreferraltotheorthopaediconcallserviceinclude:>50%displacementofthehumeralheadrelativetotheshaftAngulationontheAPorlateralx-rayof>60degreesinachild<12yearsold,or>30degreesinachild>12yearsPathologicalfractureofthepro

6、ximalhumerusAssociatedinjuries,i.e.brachialplexusinjury,vascularinjuryInassociationwithotherunilateralupperlimbfracturesMultitraumaElasticStableIntramedullaryNailsMorerecentlyproposedformoffixationAvoidmorbidityofpercutaneouspinsSofttissueirritationMigrationReq

7、uiresrepeatanestheticforremovalESINTIPS&TECHNIQUESOrthopedicsOctober2012-Volume35·Issue10:856-860CentromedullaryManipulationandStabilizationofCompletelyDisplacedProximalHumerusFracturesinAdolescents。青少年肱骨近端完全移位骨折髓内操作和稳定。Figure1:Anteroposteriorradiographofthesho

8、uldershowingthedisplacedfracture(A)andYviewradiographoftheproximalhumerusshowing100%anteriortranslationofthehumeralshaft(B).Figure2:Illustrationofapatientpositionedsupineon