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1、Radial Neck Fracturesin Children Treated With ElasticStable Intramedullary NailingNingbo No.6 hospital Caojin 为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Anatomy 为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Characteristicbegins at four years and it fuses at the age of 14 in fema
2、les and 17 in males.Ossification center为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Characteristic age 414yearsdisease rate:5%of elbow injuriesor 1%of all injuries in chindren 为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Mechanism Elbow in extension:more common typeElbow in flexe
3、d:rare type为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Classification Judet 为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能DWilkins E为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Diagnosis historysymptomphysical signradiograph为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中
4、小学图书室育人功能Treatment lcontroversylacceptable degrees 1545lthe majority opinion 30为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Reduction vClosed reductionvPercutaneous pin reductionvOpen recuction为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Closed reduction30 6060为深入学习习近平新时代中国特色社会主义
5、思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Percutaneous pin reductionRisk:radial nerve injury为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Open reductioncontroversialoutcomesincidence of complicationcauses additional damageopen reduction为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Fixati
6、on K-wiresElastic nailing为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Tecnique of elastic nailing为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Postoperative radiograph为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Case
7、 1A 6-year-old boy sustained a Judet type IV fracture of the radial neck.Follow-up radiograph after elastic nailing shows good reduction.The patient had an excellent outcome.为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Case 1Follow-up radiograph shows fracture union and anatomic reduction.
8、The patient showed an excellent clinical result and resumed full motion.为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Complication n nInfectionInfectionn nelbow elbow stiffnessstiffnessn navascular avascular necrosisnecrosisn npremature physeal closurepremature physeal closure为深入学习习近平新时代中国特
9、色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Advantage of ESINn nminimally invasive minimally invasive techniquetechniquen nstable stable fixationfixationn nearly mobilizationn nanatomical reductionn nl lower complication rateower complication raten ngood-to-excellent resultsgood-to-excellent results为深入
10、学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Case 2 10-year-old boy sustained a Judet type IV fracture of the radial neck.为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Postoperative radiograph shows anatomic reduction.The patient showed a minimal incision.为深入学习习近平新时代中国特色社会主义思想和党的十九大精
11、神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Anatomy By four years of age,the radial head and neck have assumed their adult shape with a physiological an
12、gulation of the neck in the anteroposterior(AP)plane of an average of 12.5 laterally and in the lateral plane of an average of 3.5 anteriorly.The proximal radial epiphysis is mainly supplied by periosteal blood vessels running from distal to proximal.为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图
13、书室育人功能Mechanism 2 main mechanisms of injury were described in literature.In the more common type,a radial neck fracture occurs after a fall with the elbow in extension and valgus,resulting in a fracture with valgus angulation.In the rare type,the mechanism is a fall with the elbow flexed,which cause
14、s temporary and posterior dislocation of the elbow joint.为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Treatment lThere is still some controversy about management of radial neck fractures in children.lAcceptable degrees of angulation range from 15 to 45 degrees.lWe agree with the majority w
15、ho recommend treating fractures with an angulation of less than 30 degrees with immobilization alone and those with more than 30 degrees angulation by means of surgery.为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Reduction vThe severely angulated fractures can be treated with closed reduct
16、ion,percutaneous reduction,and open Reduction.为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Open reductionopen reduction is controversial.Traditionally,it was performed if closed manipulation failed.in general,outcomes after open reduction are worse than those obtained after closed reductio
17、n.after open reduction,the incidence of complication,is higher than those after closed reduction.open reduction causes additional damage to the soft tissue,with fibrous adhesions and loss of range of motion.Some radial neck fractures are impossible to reduce with closed methods,requiring open reduct
18、ion为深入学习习近平新时代中国特色社会主义思想和党的十九大精神,贯彻全国教育大会精神,充分发挥中小学图书室育人功能Advantage of ESINn nESIN is a minimally invasive technique,ESIN is a minimally invasive technique,allowing allowing stable stable fixation,early mobilization,and fixation,early mobilization,and anatomical anatomical reduction reduction in most cases.in most cases.n nThe The complication rate is complication rate is low and low and good-to-excellent good-to-excellent results can be expected.results can be expected.