OlecranonFracturesandRadialHeadFractures鹰嘴尺骨.ppt

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1、OlecranonFracturesandRadialHeadFracturesAndrewH.Schmidt,MDGregoryJ.Schmeling,MDDavidC.Templeman,MDCreatedMarch2004AnatomyoftheOlecranonandRadialHeadSurgicalAnatomyArticularcartilageSigmoidnotchofulna:barespotCoronoidprocessNoteangleofk-wirestoengageanteriorcortexBe

2、wareofnarrowingsigmoidfossawhentreatingcomminutedfractures.OlecranonFracturesMechanismofInjuryAcuteTensionoverload:Tensionappliedbythetricepswithflexionoftheelbow.DirectTraumaChronicoverload:stressfracture,osteopenia,pediatricinjuries.EvaluationCheckintegrityofskin

3、CheckextensionofelbowEvaluateneurovascularstatus,especiallyulnarnerveX-raysinthreeviews(AP,Lat,Oblique)ImagingAPViewLateralViewObliqueViewFactorsResponsibleforElbowStabilityValgus=MedialcollateralligamentandradialheadVarus=LateralcollateralligamentCoronoidprocessS

4、igmoidFossaoftheolecranonClassificationNumerousclassifications:ColtonMorreySchatzkerAO/ASIFOTACriteriaDisplacementDirectionoffractureDegreeofcomminutionPercentinvolvementAssociatedinjuriesTypeI:Nondisplaced12%TypeII:Displaced/elbowstable82%TypeIII:Elbowunstable6%Bo

5、thtypesIIandIIIsubdividedinto:A:noncomminutedB:comminutedMayoClinicClassificationMorreyBF,JBJS77A:718-21,1995TreatmentObjectivesRestorationofthearticularsurface.Restorationandpreservationoftheelbowextensormechanism.Restorationofelbowmotionandpreventionofstiffness.P

6、reventionofcomplications.TreatmentMethodsNonoperativeOperativeExcisionofolecranonandtricepsrepairOpenreductionandinternalfixationTensionbandwirewithpinsorintramedullaryscrewsPlateIndicationsforSurgeryDisruptionofextensormechanism(anydisplacedfracture)Articularincon

7、gruityNonoperativeTreatmentNondisplacedfracturesLongarmcast-complicatedbystiffnessLong-armsplintfor7-10daysfollowedbyfunctionalbracingfor4-6weeks-complicatedbylossofreductionOlecranonExcisionAppropriateforelderlypatientsandthosewithosteoporosis,involving<50%ofjoint

8、(70%)Reattachtricepsanteriorly.Nodifferenceinisometricstrengthbutfewercomplicationsintheexcisiongroup(Gartsmanetal,JBJS63A:718,1981)SurgicalTechn