儿童肱骨近端骨折_培训课件.pptVIP

儿童肱骨近端骨折proximal humerus fracture in children Elastic Stable Intramedullary Nails 弹性髓内钉 广西中医药大学第三附属医院（柳州）王小芃 Vascular anatomy of the proximal humerus.1 Axillary artery.2 Posterior humeral circumfl ex artery.3 Anterior humeral circumfl ex artery.4 Lateral ascending branch of the anterior humeral circumfl ex artery.5 Greater tuberosity.6 Lesser tuberosity.7 Tendon insertion of the infraspinatus muscle.8 Tendon insertion of the teres minor muscle. When is reduction (non-operative and operative) required?? The proximal physis contributes 80% of the length of the humerus.? Due to the enormous remodelling potential, most of these injuries do not require reduction. ?There is no role for attempted reduction in the ED. The older child with greater deformity may be treated with closed reduction. ?This is controversial and there are no agreed figures to guide closed operative reduction. Approximate indications are: 5-12 years - accept 60 degree angulation and 50% displacement 12 years - accept 30 degrees angulation and 30% displacement Isolated greater tuberosity fractures with displacement in the adolescent are an exception group in which surgical reduction and fixation is usually required. Do I need to refer to orthopaedics now? Indications for prompt referral to the orthopaedic on call service include: 50% displacement of the humeral head relative to the shaft Angulation on the AP or lateral x-ray of 60 degrees in a child 12 years old, or 30 degrees in a child 12 years Pathological fracture of the proximal humerus Associated injuries, i.e. brachial plexus injury, vascular injury In association with other unilateral upper limb fractures Multi trauma Elastic Stable Intramedullary Nails More recently proposed form of fixation Avoid morbidity of percutaneous pins Soft tissue irritation Migration Requires repeat anesthetic for removal ESIN TIPS TECHNIQUES?Orthopedics October 2012 - Volume 35 · Issue 10: 856-860 Centromedullary Manipulation and Stabilization of Co