儿童肱骨近端骨折ppt

《儿童肱骨近端骨折ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

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.4Lateralascendingbranchoftheanteriorhumeralcircumflexartery.5Greatertu

2、berosity.6Lessertuberosity.7Tendoninsertionoftheinfraspinatusmuscle.8Tendoninsertionoftheteresminormuscle.Whenisreduction(non-operativeandoperative)required?Theproximalphysiscontributes80%ofthelengthofthehumerus. Duetotheenormousremodellingpotential,mostoftheseinjuriesdonotrequirereductio

3、n. ThereisnoroleforattemptedreductionintheED.Theolderchildwithgreaterdeformitymaybetreatedwithclosedreduction. Thisiscontroversialandtherearenoagreedfigurestoguideclosedoperativereduction.Approximateindicationsare:5-12years-accept60degreeangulationand50%displacement>12years-accept30degreesan

4、gulationand30%displacementIsolatedgreatertuberosityfractureswithdisplacementintheadolescentareanexceptiongroupinwhichsurgicalreductionandfixationisusuallyrequired.DoIneedtorefertoorthopaedicsnow?Indicationsforpromptreferraltotheorthopaediconcallserviceinclude:>50%displacementofthehumeralhead

5、relativetotheshaftAngulationontheAPorlateralx-rayof>60degreesinachild<12yearsold,or>30degreesinachild>12yearsPathologicalfractureoftheproximalhumerusAssociatedinjuries,i.e.brachialplexusinjury,vascularinjuryInassociationwithotherunilateralupperlimbfracturesMultitraumaElasticStableIntramedull

6、aryNailsMorerecentlyproposedformoffixationAvoidmorbidityofpercutaneouspinsSofttissueirritationMigrationRequiresrepeatanestheticforremovalESINTIPS&TECHNIQUESOrthopedicsOctober2012-Volume35·Issue10:856-860CentromedullaryManipulationandStabilizationofCompletelyDisplacedProximalHumerusFracturesi

7、nAdolescents。青少年肱骨近端完全移位骨折髓内操作和稳定。Figure1:Anteroposteriorradiographoftheshouldershowingthedisplacedfracture(A)andYviewradiographoftheproximalhumerusshowing100%anteriortranslationofthehumeralshaft(B).Figure2:Illustrationofapatientpositionedsupineon