儿童肘关节骨折 PPT课件.ppt

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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