儿童肘关节骨折 PPT课件.ppt

Elbow-Fractures in ChildrenFracture mechanismHyperextensionInjurytotheelbowjointisuselytheresultofhyperextensionorextremevalgusduetoafallontheoutstretchedarm.Scrollthroughtheimagesonthelefttoseehowhyperextensionleadstoasupracondylarfracture.Thehemarthroswillresultinadisplacementoftheanteriorfatpadupwardsandtheposteriorfatbackwards.Extreme valgusTheotherimportantfracturemechanismisextremevalgusoftheelbow.Thenormalelbowalreadyhasavalguspositioning.Whenachildfallsontheoutstrechtedarm,thiscanleadtoextremevalgus.Onthelateralsidethiscanresultinadislocationorafractureoftheradiuswithorwithoutinvolvementoftheolecranon.Whentheforceshavemoreeffectonthehumerus,theextremevalguswillresultinafractureofthelateralcondyle.Onthemedialsidethevalgusforcecanleadtoavulsionofthemedialepicondyle.Sometimesthemedialepicondylbecomestrappedwithinthejoint.Becauseofthevalguspositionofthenormalelbowanavulsionofthelateralepicondylewillbeuncommon.Extreme valgusTheotherimportantfracturemechanismisextremevalgusoftheelbow.Thenormalelbowalreadyhasavalguspositioning.Whenachildfallsontheoutstrechtedarm,thiscanleadtoextremevalgus.Onthelateralsidethiscanresultinadislocationorafractureoftheradiuswithorwithoutinvolvementoftheolecranon.Whentheforceshavemoreeffectonthehumerus,theextremevalguswillresultinafractureofthelateralcondyle.Onthemedialsidethevalgusforcecanleadtoavulsionofthemedialepicondyle.Sometimesthemedialepicondylbecomestrappedwithinthejoint.Becauseofthevalguspositionofthenormalelbowanavulsionofthelateralepicondylewillbeuncommon.Whenlookingatradiographsoftheelbowaftertraumaamethodicalreviewoftheradiographsisneeded.Youshouldaskyourselfthefollowingimportantquestions.Is there a sign of joint effusion?Aftertraumathisalmostalwaysindicatesthepresenceofhemarthrosduetoafracture(eithervisibleoroccult).Is there a normal alignment between the bones?Inchildrendislocationsarefrequentandcanbeverysubtle.Are the ossification centres normal?Isthepieceofbonethatyourelookingatanormalossificationcentreandisthisossificationcentreinthenormalposition.Lookespeciallyforthepositionoftheradialepiphysisandthemedialepicondyle(figure).Is there a subtle fracture?Someofthefracturesinchildrenareverysubtle.Soyouneedtobefamiliarwiththetypicalpictureofthesefractures.AlignmentTherearetwoimportantlineswhichhelpinthediagnosisofdislocationandfracture.ThesearetheRadiocapitellarlineandtheAnteriorhumeralline.Radiocapitellar lineAlinedrawnthroughthecentreoftheradialneckshouldpassthroughtthecentreofthecapitellum,whateverthepositioningofthepatient,sincetheradiusarticulateswiththecapitellum(figure).Indislocationoftheradiusthislinewillnotpassthroughthecentreofthecapitellum.Ontheleftwesee,thattheradiocapitellarlinegoesthroughcentreofthecapitellumoneveryradiogragheventhoughCandDarenotwellpositioned.NoticesupracondylarfractureinB.Radiographsofelbowsatdifferentages.TheAnteriorHumerallinegoesthroughthemiddlethirdofthecapitellumOnthelefttheanteriorhumerallinepassesthroughtheanteriorthirdofthecapitellum.Thisindicatesthatthecondylesaredisplaceddorsally(i.e.supracondylarfracture).Ossification centresThereare6ossificationcentresaroundtheelbowjoint.Theyappearandfusetotheadjacentbonesatdifferentages.Itisimportanttoknowthesequenceofappearancesincetheossificationcentersalwaysappearinastrictorder.ThisorderofappearanceisspecifiedinthemnemonicC-R-I-T-O-E(Capitellum-Radius-Internalormedialepicondyle-Trochlea-Olecranon-Externalorlateralepicondyle).Theagesatwhichtheseossificationcentresappeararehighlyvariableanddifferbetweenindividuals.Itisnotimportanttoknowtheseages,butasageneralguideyoucouldremember1-3-5-7-9-11years.TheorderofappearanceoftheossificationcentresisspecifiedinthemnemonicC-R-I-T-O-E.Supracondylar fracturesSupracondylarfractures.InAtheanteriorhumerallinepassesthroughtheanteriorthirdofthecapitellumandinBevenmoreanteriorly.NoticepositiveposteriorfatpadsigninbothcaseLateral Condyle fracturesThisfractureisthesecondmostcommondistalhumerusfractureinchildren.Theyoccurbetweentheagesof4and10years.Thesefracturesoccurwhenavarusforceisappliedtotheextendedelbow.Theytendtobeunstableandbecomedisplacedbecauseofthepulloftheforearmextensors.Sincethesefracturesareintra-articulartheyarepronetononunionbecausethefractureisbathedinsynovialfluid.LateralcondylefracturesareclassifiedaccordingtoMilch.TheyareSalter-HarrisIVepiphysiolysisfractures.MostareMilchIIfracturesthattravelfromthelateralhumeralmetaphysisabovetheepiphysisandexitthroughthelateralcristaofthetrochlealeadingtoanunstablehumeralulnararticulation.Medial Epicondyle avulsionProximal fractures of the RadiusOlecranon fractures谢谢