《儿童肘关节骨折 PPT课件.ppt》由会员分享，可在线阅读，更多相关《儿童肘关节骨折 PPT课件.ppt（29页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、Elbow-Fractures in ChildrenFracture mechanismHyperextensionInjurytotheelbowjointisuselytheresultofhyperextensionorextremevalgusduetoafallontheoutstretchedarm.Scrollthroughtheimagesonthelefttoseehowhyperextensionleadstoasupracondylarfracture.Thehemarthroswillresultinadisplacementoftheanteriorfatpadup
2、wardsandtheposteriorfatbackwards.Extreme valgusTheotherimportantfracturemechanismisextremevalgusoftheelbow.Thenormalelbowalreadyhasavalguspositioning.Whenachildfallsontheoutstrechtedarm,thiscanleadtoextremevalgus.Onthelateralsidethiscanresultinadislocationorafractureoftheradiuswithorwithoutinvolveme
3、ntoftheolecranon.Whentheforceshavemoreeffectonthehumerus,theextremevalguswillresultinafractureofthelateralcondyle.Onthemedialsidethevalgusforcecanleadtoavulsionofthemedialepicondyle.Sometimesthemedialepicondylbecomestrappedwithinthejoint.Becauseofthevalguspositionofthenormalelbowanavulsionofthelater
4、alepicondylewillbeuncommon.Extreme valgusTheotherimportantfracturemechanismisextremevalgusoftheelbow.Thenormalelbowalreadyhasavalguspositioning.Whenachildfallsontheoutstrechtedarm,thiscanleadtoextremevalgus.Onthelateralsidethiscanresultinadislocationorafractureoftheradiuswithorwithoutinvolvementofth
5、eolecranon.Whentheforceshavemoreeffectonthehumerus,theextremevalguswillresultinafractureofthelateralcondyle.Onthemedialsidethevalgusforcecanleadtoavulsionofthemedialepicondyle.Sometimesthemedialepicondylbecomestrappedwithinthejoint.Becauseofthevalguspositionofthenormalelbowanavulsionofthelateralepic
6、ondylewillbeuncommon.Whenlookingatradiographsoftheelbowaftertraumaamethodicalreviewoftheradiographsisneeded.Youshouldaskyourselfthefollowingimportantquestions.Is there a sign of joint effusion?Aftertraumathisalmostalwaysindicatesthepresenceofhemarthrosduetoafracture(eithervisibleoroccult).Is there a
7、 normal alignment between the bones?Inchildrendislocationsarefrequentandcanbeverysubtle.Are the ossification centres normal?Isthepieceofbonethatyourelookingatanormalossificationcentreandisthisossificationcentreinthenormalposition.Lookespeciallyforthepositionoftheradialepiphysisandthemedialepicondyle
8、(figure).Is there a subtle fracture?Someofthefracturesinchildrenareverysubtle.Soyouneedtobefamiliarwiththetypicalpictureofthesefractures.AlignmentTherearetwoimportantlineswhichhelpinthediagnosisofdislocationandfracture.ThesearetheRadiocapitellarlineandtheAnteriorhumeralline.Radiocapitellar lineAline
9、drawnthroughthecentreoftheradialneckshouldpassthroughtthecentreofthecapitellum,whateverthepositioningofthepatient,sincetheradiusarticulateswiththecapitellum(figure).Indislocationoftheradiusthislinewillnotpassthroughthecentreofthecapitellum.Ontheleftwesee,thattheradiocapitellarlinegoesthroughcentreof
10、thecapitellumoneveryradiogragheventhoughCandDarenotwellpositioned.NoticesupracondylarfractureinB.Radiographsofelbowsatdifferentages.TheAnteriorHumerallinegoesthroughthemiddlethirdofthecapitellumOnthelefttheanteriorhumerallinepassesthroughtheanteriorthirdofthecapitellum.Thisindicatesthatthecondylesar
11、edisplaceddorsally(i.e.supracondylarfracture).Ossification centresThereare6ossificationcentresaroundtheelbowjoint.Theyappearandfusetotheadjacentbonesatdifferentages.Itisimportanttoknowthesequenceofappearancesincetheossificationcentersalwaysappearinastrictorder.Thisorderofappearanceisspecifiedinthemn
12、emonicC-R-I-T-O-E(Capitellum-Radius-Internalormedialepicondyle-Trochlea-Olecranon-Externalorlateralepicondyle).Theagesatwhichtheseossificationcentresappeararehighlyvariableanddifferbetweenindividuals.Itisnotimportanttoknowtheseages,butasageneralguideyoucouldremember1-3-5-7-9-11years.Theorderofappear
13、anceoftheossificationcentresisspecifiedinthemnemonicC-R-I-T-O-E.Supracondylar fracturesSupracondylarfractures.InAtheanteriorhumerallinepassesthroughtheanteriorthirdofthecapitellumandinBevenmoreanteriorly.NoticepositiveposteriorfatpadsigninbothcaseLateral Condyle fracturesThisfractureisthesecondmostc
14、ommondistalhumerusfractureinchildren.Theyoccurbetweentheagesof4and10years.Thesefracturesoccurwhenavarusforceisappliedtotheextendedelbow.Theytendtobeunstableandbecomedisplacedbecauseofthepulloftheforearmextensors.Sincethesefracturesareintra-articulartheyarepronetononunionbecausethefractureisbathedins
15、ynovialfluid.LateralcondylefracturesareclassifiedaccordingtoMilch.TheyareSalter-HarrisIVepiphysiolysisfractures.MostareMilchIIfracturesthattravelfromthelateralhumeralmetaphysisabovetheepiphysisandexitthroughthelateralcristaofthetrochlealeadingtoanunstablehumeralulnararticulation.Medial Epicondyle avulsionProximal fractures of the RadiusOlecranon fractures谢谢