Open reduction and radial shaft shortening osteotomy

Open reduction and humeral shortening osteotomy for the surgical treatment of congenital humeral head dislocation. Congenital dislocation of the humeral head is rare. When the dislocation of the humeral head is long, the humeral head is small, and there is no evidence of ulnar fracture, the disease should be suspected. The X-ray shows that the humerus is long and the ulna is bow-shaped, corresponding to the humerus. The development of the small head is poor, and the humeral head of the proximal ulna is shallow or absent, and can be unilateral or bilateral. Treatment of diseases: congenital humeral head dislocation Indication Open reduction and humeral shortening osteotomy are available for: 1. Congenital humeral head dislocation, closed reduction and brace treatment failed to reset. 2. The sick child is over 3 years old, and the forearm rotation activity is normal. Contraindications The sick child is older, and the forearm passive rotation activity is severely limited. Because the forearm interosseous membrane has contracted, it is not suitable for this operation. Preoperative preparation 1. Take the X-ray films of the bilateral forearm and elbow joints, compare the affected side with the healthy side, determine the dislocation direction of the humeral head, and measure the length of the tibia overgrowth. in accordance with. 2. Adhere to the training of forearm rotation activities, especially to strengthen passive activity training to prevent interosseous membrane contracture. Surgical procedure Congenital dislocation of the humeral head can be divided into anterior dislocation and posterior dislocation. Therefore, the anterior dislocation should be performed by anterior surgical approach, open reduction and humeral shortening osteotomy and annular ligament reconstruction. The posterior surgical approach is required for the dislocation of the humeral head. Here, the surgical procedure is described by taking the posterior dislocation of the humeral head as an example. Incision From the proximal edge of the upper arm and the proximal end of the upper iliac crest at 7cm, the longitudinal extension to the superior iliac crest, and then the posterior to the posterior ulna, followed by the ulna to the distal end, ending at nearly 1/3 of the ulna At the office. 2. Reveal the upper ankle joint Cut the skin and deep fascia along the incision line. First find the gap between the elbow muscle and the ulnar wrist extensor muscle, separate the elbow muscle and the ulnar wrist extensor muscle gap, and pull the latter to the inner side. The elbow muscle is peeled off from the ulnar olecranon and the proximal end of the ulna and turned to the proximal end. Then cut off the supinating attachment point of the supinator muscle in the ulna and the tibia, and lead to the proximal end, revealing the proximal 1/3 of the ulna and the upper ulnar joint. Care should be taken to protect the dorsal nerves between the bones. 3. Short bone osteotomy and fixation After exposing the upper ulnar joint, the humeral head was dislocated backward and the changes of the annular ligament were observed. Because the tibia is relatively long, it is quite difficult to reset, even impossible to reset. At this time, the short incision should be made in the upper incision in the same incision, and the length of the truncated bone should be based on the preoperative X-ray. The slice was measured to determine the condition of the tibia growth. After the shortening of the humerus, the reduction of the humeral head becomes easier. A fine Kirschner wire was inserted from the proximal medullary cavity of the osteotomy, through the small head of the humerus and the small head of the humerus, and passed through the skin behind the elbow. When the tail end exposes the proximal end of the osteotomy, the osteotomy ends are aligned, and the end of the Kirschner wire is inserted into the distal medullary cavity of the osteotomy until 1/3 of the distal end of the humerus. 4. Reconstruct the annular ligament A 1 cm × 8 cm size tendon was cut outside the triceps tendon, and the ulnar periosteum was peeled from the proximal end to the distal end, and the distal attachment point of the tendon was retained. In addition, a bone hole is drilled at the ulna of the humeral neck to fix the reconstructed annular ligament. The tendon bundle is bypassed from the front of the humerus neck to the ulnar side, and then passed through the bone hole at the proximal end of the ulna from the front to the back, and is taken out from the posterior aspect of the ulna. The shin is sutured and fixed to the periosteum of the ulna.