Radial Head & Neck Fractures In Children - Everything You Need To Know - Dr. Nabil Ebraheim

Описание: Dr. Ebraheim’s educational animated video describing fractures of the radial head and neck in children.
Fractures of the radial head and neck are not common in children. The fracture can de non-displaced, displaced , tilted or translocated. These types of fractures are rare. They usually occur around 9 years of age, usually due to valgus force. Fracture may involve the physis (growth plate). It is a Salter II fracture or it may involve the radial neck at the metaphysis.
There is a mnemonic statement that can be used to remember the names and order of the elbow ossification centers: CRTITOE 1 3 5 7 1 1
•Capitellum 1 year
•Radial head 3 years
•Internal epicondyle(medial) 5 years
•Trochlea 7 years
•Olecranon 9 years
•External epicondyle (lateral) 11 years.
An AP and lateral view of the elbow including forearm should be taken. The radial head should align with the capitellum in all views. Radial head capitellar views may be helpful to view the radial head. Radiocapitellar view, the beam is directed 45 degrees proximally.
Treatment
•Nondisplaced fracture: immobilization: immobilization is used if angulation is less than 30 degrees. Up to 30 degrees of angulation is acceptable.
•Closed reduction is used if angulation is greater than 30 degrees.
How to do closed reduction?
Reduction of the radial neck fracture is done with elastic bandage around the forearm and elbow or with extension of the elbow, traction ,supination and direct varus pressure over the radial head. Push the radial head medially and push the radial shaft laterally. Immobilization if the reduction is acceptable. After reduction, the radial head usually stays in its position due to the periosteum. K-wire joystick may be used for reduction. Open reduction if more than 45 degrees residual angulation after failure of reduction closed or percutaneous method.
Complications
•Synostosis: fusion of the radius to the ulna. Reflected periosteum is a possible cause of synostosis.
•Loss of motion
•Osteonecrosis: due to interruption of the blood supply.
•Nonunion: (rare): interposition of the periosteum is a possible cause.
•Risk and complications increase with open reduction. Open reductions is the last resort.
With fracture of the radial head in children, repeat neurovascular examination should be done.
Compartment syndrome of the forearm should be suspected in case of increased pain or increased narcotic requirement.



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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step