桡骨小头骨折切开内固定术.pptVIP

桡骨小头骨折切开内固定术 Preoperative AP radiograph of a Type 2 radial head fracture. Preoperative lateral radiograph of a Type 2 radial head fracture. Preoperative lateral radiograph of the Type 2 radial head fracture. The elbow is flexed and positioned on a radiolucent table. The incision begins just above the lateral epicondyle and extends down towards the ulna, passing directly over the radial head, as depicted. The skin incision is brought down through the subcutaneoustissue and the common extensor origin is identified. The common extensor origin is incised between the anconeus and the extensor carpi ulnaris over the capitellum radial head.ANCONEUSECU The upper edge of the capitellum and the radial head are exposed. RADIAL HEAD With sharp retraction and rotation of the radial head, the fracture is identified. Care must be taken not to extend this incision too far distally, as this may damage to the posterior interosseous nerve, as it lay over the radial neck.ANNULARLIGAMENTRADIAL HEAD FRACTURE A Freer elevator or small osteotome is introduced tomobilize the radial head fracture. Close up viewCAPITELLUMRADIAL HEAD After anatomic reduction is achieved, K-wires are used to maintain the reduction.K-WIREREDUCTION After anatomic reduction is achieved, K-wires are used to maintain the reduction.K-WIREREDUCTION Using the external jig, a screw is placed such that it is countersunk below the articular surface of the radial head. In this example, a solid Herbert screw is utilized. The reduced and fixed radial head. The Herbert screw seated under the articular surface. Occasionally, the second K-wire is exchanged for a Herbert screw. FRACTUREHERBERTSCREW The range of motion of the forearm as well as pronation andsupination are confirmed, and the reduction is visualizedthroughout in arc of motion of the elbow. If adequately fixedand stable, closure is performed.FRACTUREHERBERTSCREW The common extensor mechanism is brought together,enclosed over the radio-capitellar joint. After