Open reduction and internal fixation of radial neck fractures

In addition to the humeral head, the humeral head constitutes the ankle joint, and the ulna constitutes the upper ulnar and ankle joints, and both have a rotating function. If the humeral neck fracture leads to angular displacement, it can not only cause rotational dysfunction, but also cause arthritis of injury. Therefore, if the shift exceeds 30°~60°, the manual reset fails, or if the resetter is failed with the K-wire under X-ray fluoroscopy, the cut should be performed. Treatment of diseases: radial head fractures and radial head fractures Indication In addition to the humeral head, the humeral head constitutes the ankle joint, and the ulna constitutes the upper ulnar and ankle joints, and both have a rotating function. If the humeral neck fracture leads to angular displacement, it can not only cause rotational dysfunction, but also cause arthritis of injury. Therefore, if the shift exceeds 30°~60°, the manual reset fails, or if the resetter is failed with the K-wire under X-ray fluoroscopy, the cut should be performed. Preoperative preparation 1. The fracture is caused by severe trauma. The patient has severe pain and blood loss. Analgesic and blood matching should be given before surgery. For patients with poor general condition or existing shock, anti-shock treatment such as infusion and blood transfusion should be given, and the operation should be performed after the condition is stable. 2. Preoperative fracture site should be taken with positive lateral x-ray film to determine the location, shape and displacement of the fracture, which is convenient for determining the surgical procedure and internal fixation. For those who need to take x-rays during surgery, they should inform the radiology department and the operating room in advance to prepare. 3. The surgeon should propose the special equipment to be used and check whether the preparation of the equipment is complete, so as to avoid temporary preparation and prolong the operation time. 4. Open fractures should be treated with antibiotics and tetanus antitoxins; or if the original open fractures were delayed for more than 2 weeks, antibiotics and repeated injections of tetanus antitoxin should be used. 5. After the reduction and reduction, the internal fixation or bone graft should be used. The antibiotic should be intravenously administered immediately after anesthesia, and once every 6 hours, share 4 times. 6. The fracture site should have sufficient range of cleaning and disinfection preparations. The surgeon should avoid contact with the suppurative wound on the same day, and strictly follow the hand washing procedure to prevent the wound infection. 7. Patients who need to delay surgery for the first time should be towed first, can be reset, temporarily fixed, and can overcome soft tissue contracture, reducing the difficulty of resetting during surgery. 8. Need to simultaneously bone fractures, such as delayed bone fractures, slow healing fractures, etc., should be prepared for the bone area after surgery. Surgical procedure 1. Position: supine position, abducting upper limbs, forearm pronation is placed on the small table next to the operating table, or the elbow is placed on the chest. 2. Incision, exposure: Use the posterior side of the humeral head to reveal the way, separate the elbow muscle and the ulnar side of the wrist muscle gap, cut the switch capsule, expose the humeral head, and avoid damage to the deep branch of the radial nerve. 3. Reposition, internal fixation: After revealing the head of the humerus, the hematoma is removed, and the humeral head is often angularly displaced. Children with humeral neck fractures often have green branch fractures. The lateral periosteum is not broken. When resetting, just push the humeral head gently with your finger to correct the angular displacement. Do not use excessive force or overcorrection to completely tear the periosteum. The humeral head loses blood supply and causes ischemic necrosis. In addition, disable the instrument clamp to clamp the humeral head to avoid damage to the epiphysis. Rotate the forearm after resetting to observe the stability of the reset. It is more stable without internal fixation, but it must be tested at which position is the most stable (generally the most stable in the rotation of the elbow 135°), which can be fixed with plaster cast. This location. If it is unstable or osteophyte separation, the elbow should be bent at 90°, and the humeral neck fracture should be fixed in the medullary cavity by using the Kirschoffus to the longitudinal axis of the humerus. The Kirschner wire should be exposed to the skin or left under the skin. After the Kirschner wire is fixed, the elbow joint can no longer be flexed to prevent the Kirschner wire from breaking. Finally, the joint cavity was cleaned and sutured according to the layer. The exposed K-wire was properly wrapped and the plaster was externally fixed.