尺骨鹰嘴骨折AO治疗原则
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
To allow early motion of the elbow, it is essential to achieve precise and stable anatomical reconstruction of the different ring structures that make up this anatomy
Introduction
Olecranon fracture can lead to severe dysfunction, arising from posttraumatic instability, impingement, soft-tissue contracture, malunion, or nonunion.
2、Treatment plan
Most olecranon fractures need open reduction and internal
fixation.
For cases with extended elbow devices intact and without displacement, non operative treatment can be chosen. In view of the eccentric traction of triceps tendon, the fixation of fracture needs to follow the tension band principle.
Thank for your listening!
5、Postoperative treatment
• In the first 24-48 hours after the operation, the use of rear brace can increase patient comfort, but it is not necessary. If the fracture ends are stable, the patient can safely exercise the affected limb. • A few days after the operation, active function training can be carried out under auxiliary. • Within 1 week after operation, active functional exercise should be closely monitored to avoid contracture of the elbow joint.
II. Most patients have functional recovery of elbow joint mobility.
III. Despite the mild limitation of elbow extension, there is no obvious dysfunction.
3、Preoperative plan—Reset technology and instruments
wenku.baidu.com
For fractures, involving the Joint, Direct Reduction can be achieved with
Bone Hook
Point Reduction forceps Kirschner Wire
6、Hidden trouble and complication
• Kirschner wire withdrew and ejection skin. • Pain • Fracture nonunion, rare
7、Clinical efficacy
I. Most ulnar olecranon fractures can be healed by first intention.
4、Surgical skills
• After flushing and clearing the joint cavity, the fragment should be repositioned, and the compressed joint surface must be fully raised to restore the anatomical structure. • For oblique fractures, in order to prevent displacement, one lag screw may be inserted perpendicular to the fracture line before tension band fixation. • For complex comminuted fractures, indirect reduction is preferable: 3.5mm LCP or remodeled proximal ulnar reconstruction plate is optional for the implant. The proximal screws should be placed in the direction of the pulp cavity and perpendicular to other screws to form an interlocking structure.
Note:
The involution of radial head and humeral head must be carefully evaluated to identify whether there is displacement or instability. Simple transverse or oblique fractures are not necessarily stable because they can be associated with dislocation of the elbow or forearm.
Olecranon fracture
Shandong Provincial Hospital
Introduction
Fracture and Soft tissue assessm ent
Treatme nt plan
Preopera tive plan
Surgical skills and points
stainless steel wires (1 mm or 2 mm) were circumscribed. Oblique fracture should be fixed with 1 screws to achieve balanced pressure. For comminuted fractures and fractures involving the distal coronoid process, the posterior plate (1/3 tubular plate, reconstruction plate or 3.5mm LCP) is preferable, and the shaping 3.5mm olecranon anatomical LCP is also preferable.
Postoper ative treatmen t
Hidden trouble and complica tion
Clinical efficacy
Introduction
The olecranon is close to the skin and is prone to fracture under direct violence. Ulnar olecranon fracture caused by hyperextension and torsion is the most common type of elbow injury.
3、Preoperative plan
Position and surgical approach
Reset technology and instruments
Selection of internal plants and principle of tension band
3、Preoperative plan—Position and surgical approach The posterior approach was used to cut the skin incision from the supracondylar fracture of the humerus to the distal end of the fracture 4~5cm. The incision can slightly bend to the radial side to protect the ulnar nerve and avoid contusion and laceration of the skin. Too large flap may cause difficulty in healing and should be avoided. Since splitting the elbow muscle fibers may result in loss of innervation, it is necessary to strip the elbow muscle close to the ulna and expose the elbow joint.
1、Fracture and soft tissue assessment
Olecranon fractures are typically transverse and oblique type B1 fractures in which elbow extensors are destroyed by bending stresses acting on the distal humerus. With the increase of external force, the central part of olecranon articular surface may be comminuted and compressed, and even the avulsion fracture of coronal process may occur. The patient complained of pain and unable to move the elbow joint. The local skin presented swelling, congestion or contusion.
3、Preoperative plan—Selection of internal plants and principle of tension band
Simple transverse or oblique fractures, two Kirschner wires (1.8
mm or 1.6 mm) were used as internal splints and one or two
Introduction
Olecranon fracture can lead to severe dysfunction, arising from posttraumatic instability, impingement, soft-tissue contracture, malunion, or nonunion.
2、Treatment plan
Most olecranon fractures need open reduction and internal
fixation.
For cases with extended elbow devices intact and without displacement, non operative treatment can be chosen. In view of the eccentric traction of triceps tendon, the fixation of fracture needs to follow the tension band principle.
Thank for your listening!
5、Postoperative treatment
• In the first 24-48 hours after the operation, the use of rear brace can increase patient comfort, but it is not necessary. If the fracture ends are stable, the patient can safely exercise the affected limb. • A few days after the operation, active function training can be carried out under auxiliary. • Within 1 week after operation, active functional exercise should be closely monitored to avoid contracture of the elbow joint.
II. Most patients have functional recovery of elbow joint mobility.
III. Despite the mild limitation of elbow extension, there is no obvious dysfunction.
3、Preoperative plan—Reset technology and instruments
wenku.baidu.com
For fractures, involving the Joint, Direct Reduction can be achieved with
Bone Hook
Point Reduction forceps Kirschner Wire
6、Hidden trouble and complication
• Kirschner wire withdrew and ejection skin. • Pain • Fracture nonunion, rare
7、Clinical efficacy
I. Most ulnar olecranon fractures can be healed by first intention.
4、Surgical skills
• After flushing and clearing the joint cavity, the fragment should be repositioned, and the compressed joint surface must be fully raised to restore the anatomical structure. • For oblique fractures, in order to prevent displacement, one lag screw may be inserted perpendicular to the fracture line before tension band fixation. • For complex comminuted fractures, indirect reduction is preferable: 3.5mm LCP or remodeled proximal ulnar reconstruction plate is optional for the implant. The proximal screws should be placed in the direction of the pulp cavity and perpendicular to other screws to form an interlocking structure.
Note:
The involution of radial head and humeral head must be carefully evaluated to identify whether there is displacement or instability. Simple transverse or oblique fractures are not necessarily stable because they can be associated with dislocation of the elbow or forearm.
Olecranon fracture
Shandong Provincial Hospital
Introduction
Fracture and Soft tissue assessm ent
Treatme nt plan
Preopera tive plan
Surgical skills and points
stainless steel wires (1 mm or 2 mm) were circumscribed. Oblique fracture should be fixed with 1 screws to achieve balanced pressure. For comminuted fractures and fractures involving the distal coronoid process, the posterior plate (1/3 tubular plate, reconstruction plate or 3.5mm LCP) is preferable, and the shaping 3.5mm olecranon anatomical LCP is also preferable.
Postoper ative treatmen t
Hidden trouble and complica tion
Clinical efficacy
Introduction
The olecranon is close to the skin and is prone to fracture under direct violence. Ulnar olecranon fracture caused by hyperextension and torsion is the most common type of elbow injury.
3、Preoperative plan
Position and surgical approach
Reset technology and instruments
Selection of internal plants and principle of tension band
3、Preoperative plan—Position and surgical approach The posterior approach was used to cut the skin incision from the supracondylar fracture of the humerus to the distal end of the fracture 4~5cm. The incision can slightly bend to the radial side to protect the ulnar nerve and avoid contusion and laceration of the skin. Too large flap may cause difficulty in healing and should be avoided. Since splitting the elbow muscle fibers may result in loss of innervation, it is necessary to strip the elbow muscle close to the ulna and expose the elbow joint.
1、Fracture and soft tissue assessment
Olecranon fractures are typically transverse and oblique type B1 fractures in which elbow extensors are destroyed by bending stresses acting on the distal humerus. With the increase of external force, the central part of olecranon articular surface may be comminuted and compressed, and even the avulsion fracture of coronal process may occur. The patient complained of pain and unable to move the elbow joint. The local skin presented swelling, congestion or contusion.
3、Preoperative plan—Selection of internal plants and principle of tension band
Simple transverse or oblique fractures, two Kirschner wires (1.8
mm or 1.6 mm) were used as internal splints and one or two