桡骨小头骨折切开内固定术.pptxVIP

桡骨小头骨折切开内固定术第1页/共22页 Preoperative AP radiograph of a Type 2 radial head fracture.第2页/共22页 Preoperative lateral radiograph of a Type 2 radial head fracture.第3页/共22页 Preoperative lateral radiograph of the Type 2 radial head fracture.第4页/共22页 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.第5页/共22页 The skin incision is brought down through the subcutaneoustissue and the common extensor origin is identified.第6页/共22页 The common extensor origin is incised between the anconeus and the extensor carpi ulnaris over the capitellum radial head.ANCONEUSECU第7页/共22页 The upper edge of the capitellum and the radial head are exposed.第8页/共22页 RADIAL HEAD第9页/共22页 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第10页/共22页 A Freer elevator or small osteotome is introduced tomobilize the radial head fracture.第11页/共22页 第12页/共22页 Close up viewCAPITELLUMRADIAL HEAD第13页/共22页 After anatomic reduction is achieved, K-wires are used to maintain the reduction.K-WIREREDUCTION第14页/共22页 After anatomic reduction is achieved, K-wires are used to maintain the reduction.K-WIREREDUCTION第15页/共22页 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.第16页/共22页 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第17页/共22页 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 st