鹰嘴桡骨头骨折（英文）.ppt

Olecranon Fractures and Radial Head Fractures Andrew H. Schmidt, MD Gregory J. Schmeling, MD David C. Templeman, MD Anatomy of the Olecranon and Radial Head Surgical Anatomy Articular cartilage Sigmoid notch of ulna: bare spot Coronoid process Note angle of k-wires to engage anterior cortex Beware of narrowing sigmoid fossa when treating comminuted fractures. Olecranon Fractures Mechanism of Injury Acute Tension overload: Tension applied by the triceps with flexion of the elbow. Direct Trauma Chronic overload: stress fracture, osteopenia, pediatric injuries. Evaluation Check integrity of skin Check extension of elbow Evaluate neurovascular status, especially ulnar nerve X-rays in three views (AP, Lat, Oblique) Imaging Factors Responsible for Elbow Stability Valgus = Medial collateral ligament and radial head Varus = Lateral collateral ligament Coronoid process Sigmoid Fossa of the olecranon Classification Numerous classifications: Colton Morrey Schatzker AO/ASIF OTA Criteria Displacement Direction of fracture Degree of comminution Percent involvement Associated injuries Mayo Clinic Classification Type I: Nondisplaced 12% Type II: Displaced/ elbow stable 82% Type III: Elbow unstable 6% Both types II and III subdivided into: A: noncomminuted B: comminuted Treatment Objectives Restoration of the articular surface. Restoration and preservation of the elbow extensor mechanism. Restoration of elbow motion and prevention of stiffness. Prevention of complications. Treatment Methods Nonoperative Operative Excision of olecranon and triceps repair Open reduction and internal fixation Tension band wire with pins or intramedullary screws Plate Indications for Surgery Disruption of extensor mechanism (any displaced fracture) Articular incongruity Nonoperative Treatment Nondisplaced fractures Long arm cast - complicated by stiffness Long-arm splint for 7-10 days followed by functional bracing for 4-6 weeks - complicated by loss of reduction Olecranon Excision Appro