Surgery for radial head and radial neck fractures

The incidence of upper ulnar fractures was olecranon fracture, humeral head fracture and osteophyte separation, and ulnar coronoid process fracture. According to reports in the literature, they accounted for 0.98%, 0.88%, 0.75%, and 0.2% of total body fractures, respectively. The olecranon fractures ranked 29th and the radial head fractures were 32, all of which were common fractures. Treatment of diseases: humeral neck fracture, sacral small skull sputum separation Indication The operation of the humeral head and the humeral neck fracture is applicable to: 1. The comminuted fracture of the humeral head and neck, the fracture piece is separated and displaced; more than 1/3 of the humeral head and cleft palate fracture and obvious displacement, feasible humeral head resection. 2. The fracture of the humeral neck or the small skull is separated, and the angular displacement is >60°. If the method fails or the reduction is failed, the open reduction should be performed. 3. After the small head resection of the adult humeral head comminuted fracture, the conditional person can perform the artificial humeral head replacement in one stage. Contraindications It is not advisable for children to have a small head resection. Preoperative preparation For artificial humeral head replacement, appropriate size artificial heads and corresponding tools should be prepared. The artificial small head is generally made of silicone rubber or stainless steel or titanium alloy. Surgical procedure 1. Excision of Radial Head (1) The operation is performed under the balloon tourniquet. The posterior lateral incision of the elbow joint was used from the external iliac crest and stopped 4 to 5 cm below the humeral head. (2) After cutting the deep fascia, cut along the posterior elbow muscle and the ulnar wrist extensor muscle and retract to both sides to reveal the posterior capsule. (3) Longitudinal incision switch sac, revealing the humeral head, it can be seen that the humeral head has been pulverized. Remove blood from the joints and examine the fractures carefully. Use gauze to protect the joint cavity and prevent bone chips from falling in. If the humeral head fracture, the broken humeral head can be removed from the upper edge of the annular ligament with a bone knife; if the humeral neck fracture, the annular ligament should be cut and removed from the upper edge of the humerus. The osteotomy is to be leveled. Remove the gauze, flush the joint cavity with isotonic saline, and carefully check for small debris falling into the joint cavity. Loose tourniquet to stop bleeding. (4) Cover the osteotomy surface with surrounding soft tissue and suture several needles intermittently. The incision was sutured by layer and the thick dressing was properly pressure bandaged. 2. Open Reduction of Fracture of Radial Neck (1) The posterior lateral incision of the elbow joint is used to expose the humeral head. Check the angular displacement direction of the humeral head. Pass the forearm passively and observe its displacement. Remove blood from the joints. Then the surgeon gently pushes the thumb upwards and then pushes the tilted humeral head to reset the angle. After the reduction, try to flex the elbow joint and rotate the forearm to see if the humeral head is displaced and where it is most stable. It is usually most stable when the elbow joint is flexed to a position of 130° to 140° and the forearm is neutral. It should be fixed at this position after surgery. (2) Generally, there is no need for internal fixation, especially for children. If the reduction, the small head of the humerus is extremely unstable. The elbow joint can be flexed to 90°, and a 1~1.5mm Kirschner wire is drilled from the back of the lower end of the humerus. The small head of the humerus and the small head of the humerus enter the medullary cavity of the humerus to fix the fracture. Cut the tail of the needle and bend it to the outside of the skin. The incision is then sutured by layer. (3) It is also possible to use an absorbable screw to be fixed obliquely forward and forward from the humeral head joint surface, and the screw tail should be lower than the articular cartilage plane. 3. Artificial humeral head replacement (Arthroplasty of Radial Hoad) The posterior lateral approach of the elbow joint was exposed and the humeral head was removed. The humeral neck stump was repaired, and the proximal medullary cavity of the humerus was enlarged with a medullary cavity expander to fit the shank of the artificial humeral head. The selected artificial humeral head is then trially inserted. Observe the size and contact surface. If appropriate, try to move the elbow joint and rotate the forearm to see if the artificial small head is stable. After complete hemostasis, the joint capsule and various layers of tissue are sutured. complication 1. After the removal of the adult humeral head, some patients may have symptoms of dislocation of the lower ankle joint. Therefore, it is feasible to have artificial small head replacement to prevent dislocation or subluxation of the lower ankle joint and affect the wrist strength. 2. The main complication after artificial humeral head replacement is infection. therefore. Emphasis on surgical operation carefully and completely stop bleeding, strict aseptic technique. Another important complication is loosening of the prosthesis, especially in cases of ring-shaped ligament rupture, which should be repaired during surgery. It should be braked for 2 weeks after operation. After the annular ligament and joint capsule are healed, it is better to do functional exercise.