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Radial head dysplasia

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Abnormal humeral head development due to disease. In children under 4 years old, the humeral head is underdeveloped, the annular ligament is slack, and it is prone to subluxation due to pulling. The sacral dysplasia is common in chromosomal abnormalities and some syndromes, such as 18-trisomy syndrome, 13-trisomy syndrome, thrombocytopenia, urinary system malformation, etc. Ultrasound mainly shows that the humerus is extremely short, with a curvature, and the thumb is almost Touch the inside of the forearm, or do not see the display. Tibial dysplasia: clinical manifestations of nail-sacral syndrome: individual with humeral head dysplasia and ankle joint abnormalities. In children under 4 years old, the humeral head is underdeveloped, the annular ligament is slack, and it is prone to subluxation due to pulling. Pain, swelling, deformity, dysfunction, and joint-to-part relationship were abnormal after dislocation. X-ray films can be diagnosed and can be combined with or without fractures and other pathological changes. Treatment is mainly based on manual reduction, and should not be rude. The reset is not successful until the reset is successful. After resetting for 3 weeks, start active movement, supplemented by gentle passive movement, restore joint movement and muscle strength, and do not passively massage.

Cause

Cause

The articular surface of the humeral head and the longitudinal axis of the humerus have a certain inclination, and its size is related to the rotation of the forearm. The change in inclination affects the up and down movement of the annular ligament. In the pronation of the forearm, the variability of the inclination undoubtedly makes it easy to dislocate. When the elbow joint is straight or the forearm is suddenly pulled by the longitudinal movement of the rotating motion, the lower part of the annular ligament will have a horizontal tear, a slight downward movement, the ankle joint gap becomes larger, and the joint capsule and the upper part of the annular ligament are due to the joint cavity. The negative pressure action only needs to slide over the distal part of the humerus to tilt the distal end of the articular surface to be incarcerated in the tibial joint space, thereby preventing the reduction of the humeral head and causing the humeral head to subluxate.

Examine

an examination

Related inspection

CT examination of serum osteocalcin (BGP) limbs and joints flat Loire

1, symptoms: itchy, running water, accompanied by earache, redness and swelling.

2, check: see the external auditory canal and drum covered with yellow or white powder or fluffy coating, sometimes secretions or suede in a cylindrical shape, after removal, see the affected area slightly humidified. When combined with bacterial infection, there may be earache and pus. Light can also be asymptomatic, only found when checking.

3, complications: easy to merge with other infections.

Diagnosis

Differential diagnosis

In the differential diagnosis, the dislocation of the humeral head and the subluxation of the humerus are distinguished. The main points are as follows:

(1) The humeral head subluxation is common in children aged 2-4 years. Because the humeral head is not fully developed, the annular ligament is loose. When it is pulled strongly, it is prone to dislocation, and the humeral head is pulled to the far end of the funnel ring ligament. On the side, sometimes part of the ligament is embedded between the ankle joints.

(2) There is often a history of injury to the child's arm up the stairs or walking.

(3) The child was crying during the subluxation, elbow pain, half flexion of the elbow, moderate forefront of the forearm, no fear of twisting and elbow flexion, refused to lift and move the affected limb, tenderness of the humeral head, X The line check is negative.

(4) Do not use anesthesia during resetting, first rotate the forearm, stretch the elbow and pull it slightly, press the elbow to the elbow and bend the elbow joint, and if necessary, rotate the forearm back and forth to feel the sound of the reset, the elbow after resetting. The forearm can move freely.

(5) After resetting, use a triangle towel to suspend for one week.

(6) If the pain or recurrence during the activity, it is best to use plaster to fix the elbow at 90 degrees for 2 weeks. Care should be taken not to lift the child's arm to prevent recurrence.

(7) When the humeral head grows up around 5 years old, it is not easy to get out.

(8) Note that the dislocation of the humeral head is mostly congenital, rarely seen, no history of trauma in children, elbow can be paralyzed and dislocated, and the X-ray film shows dislocation of the humeral head, which can confirm the diagnosis.

(9) In infants and young children, the dislocation of the radial head can be attempted to close and reset. The posterior tibial position of the humeral head is fixed and the elbow joint is fixed in the straight position, while the elbow flexion is fixed in the anterior tibial dislocation. The cast is fixed for 4-6 weeks after resetting. Poor efficacy.

(10) The treatment of humeral head dislocation surgery should be performed after the age of 3 years. The humeral head is used for open reduction and reconstruction, and the shortening osteotomy and annular ligament reconstruction at the anterior humerus attachment point of the humeral shaft. Temporary fixation of the humeral head and the humeral head with a Kirschner wire. After the plaster was fixed for 6 weeks, the Kirschner wire was removed.

(11) Larger children with humeral head dislocation because of the inability to reset, can be considered adolescent period of humeral head resection.

In addition, clinically, the subluxation of the humeral head needs to be differentiated from the soft tissue injury of the elbow joint, the external humerus fracture, and the radial head fracture.