Open reduction of radial head dislocation

Simple humeral head dislocation is rare, most of the humeral head dislocation and 1/3 of the ulnar fracture. The dislocation of the humeral head generally has an annular ligament rupture, and the fractured annular ligament can be embedded between the upper and lower ankle joints to prevent the reduction. In addition, the upper end of the humerus has biceps attachment, and under the condition of the rupture of the annular ligament, the contraction of the biceps tend to cause dislocation of the humeral head. Therefore, the old dislocation of the humeral head, or the failure of the fresh dislocation, or the dislocation of the fresh dislocation, or the dislocation of the humeral head and the injury of the sacral nerve should be performed with open reduction and reconstruction of the ligament. Treatment of diseases: humeral head subluxation humeral head fracture Indication Simple humeral head dislocation is rare, most of the humeral head dislocation and 1/3 of the ulnar fracture. The dislocation of the humeral head generally has an annular ligament rupture, and the fractured annular ligament can be embedded between the upper and lower ankle joints to prevent the reduction. In addition, the upper end of the humerus has biceps attachment, and under the condition of the rupture of the annular ligament, the contraction of the biceps tend to cause dislocation of the humeral head. Therefore, the old dislocation of the humeral head, or the failure of the fresh dislocation, or the dislocation of the fresh dislocation, or the dislocation of the humeral head and the injury of the sacral nerve should be performed with open reduction and reconstruction of the ligament. Surgical procedure 1. Position: lying on the back, the injured limb is abducted 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 and the upper part of the humerus (see the posterior side of the approach), separate from the elbow muscle and the ulnar wrist muscle, cut the supinator muscle along the ulnar edge, and turn to the temporal side , you can reveal the humeral head and neck. 3. Reset: If the monteggia fracture (foot fracture, humeral head dislocation), generally first reset and internal fixation of the upper 1/3 of the ulna fracture, then remove the embedded joint capsule and annular ligament between the ruler and supraorbital joint, with the thumb Push the humeral head back to the ulnar side to reset. In the case of old dislocation, the scar tissue in the upper and lower jaw joints must be removed and can be reset. 4. Reconstruct the annular ligament: firstly align the broken ends of the annular ligament, check whether it can be directly sutured, and if possible, suture with silk thread. In general, most of the annular ligaments cannot be sutured directly and reconstruction is required. There are three methods: 1 On the myofascial fascia near the ulna, take a 1.0 × 10 cm pedicled fascia strip, the pedicle is flattened and the distal end is cut. The fascia strip bypasses the front of the humeral neck and passes through the lateral and posterior to the pedicle. Under appropriate tightness (the humeral head can be fixed without affecting the rotational movement of the humerus), the ligament is sutured with a silk thread. 2 The fascia strip (1.0×10cm2) can also be used for reconstruction. Firstly, the fascia lata is folded and sutured so that the smooth surface faces outward, and then 2 to 3 holes are drilled side by side at the cusp of the ulna, so that the holes communicate with each other to form a fissure. The fascia strip was passed through the ulnar fissure, and the dorsal half was passed around the front of the humerus, returned to the ulnar fissure, and sutured with silk thread. The volar fascia strip was then wound from the front of the humerus to the back of the humerus, and the fascia strip of the ulnar fissure was sutured with silk. 3 Reconstruct the annular ligament with a 2mm diameter silicone tube instead of the fascia strip. The method is reconstructed with the fascia strip. After hemostasis, suture layer by layer.