上肢骨折和手外伤课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,上肢骨折和手外伤课件,*,Clavicle Fractures锁骨骨折,Anatomy,上肢骨折和手外伤课件,1,Clavicle Fractures锁骨骨折Anatomy,Causes of Clavicle Fracture,Accidents such as,falls,Sometimes,a blow,from a blunt object or,a collision,of some sort,上肢骨折和手外伤课件,2,Causes of Clavicle FractureAcc,Fracture Classification,Fracture of middle 1 / 3 ( group I ),account for 80 %,上肢骨折和手外伤课件,3,Fracture Classification Fractu,frx of distal 1/3 (group II),account for 10-15% type I: minimal displacement type II: frx medial to,coracoclavicular ligaments type III: articular surface fractures,frx of medial 1/3 (group III),account for 5%,上肢骨折和手外伤课件,4,frx of distal 1/3 (group II),Symptoms of Clavicle Fracture,Pain,Swelling,Tenderness,Deformity,Internal bleeding,If asked to lift their arm, patients with a broken clavicle cannot do so without extreme pain.,上肢骨折和手外伤课件,5,Symptoms of Clavicle FractureP,Treatment of Clavicle Fracture,The goal of treating broken bones is to set them, making them whole again,figure-8 splint or strap immobilized for 6-8 weeks,Open reduction and internal fixation,上肢骨折和手外伤课件,6,Treatment of Clavicle Fracture,Humerus Shaft Fractures 肱骨干骨折,上肢骨折和手外伤课件,7,Humerus Shaft Fractures 肱骨干骨折,Causes of Humeral Shaft Fracture,Direct stress, such as a blow to the arm.,Indirect forces,such as a fall,twisting or torsional forces.,上肢骨折和手外伤课件,8,Causes of Humeral Shaft Fractu,mechanism,bending force produces transverse frx of the shaft;,torsion force will result in a spiral fracture;,combination of bending and torsion produce oblique frx w/ or w/o a butterfly fragment;,compression forces will frx either proximal or distal ends of humerus;,上肢骨折和手外伤课件,9,mechanismbending force produce,types of humeral shaft fracture,Transverse humeral fractures,Short oblique fractures,Long spiral fractures,上肢骨折和手外伤课件,10,types of humeral shaft fractur,Symptoms of humeral shaft fracture,Pain,Loss of strength in the grip,Swell,Deformity,Tenderness,If the blood supply is impaired, there may be numbness and coldness in the arm and hand.,上肢骨折和手外伤课件,11,Symptoms of humeral shaft frac,Non Operative Treatment of Humeral Shaft fracture,Long arm splint needs to be applied from shoulder to wrist to fully immobilize the extremity;,上肢骨折和手外伤课件,12,Non Operative Treatment of Hum,Operative Treatment:,internal fixation should be reserved for fractures with inadequate reduction or patients with multiple trauma;,上肢骨折和手外伤课件,13,Operative Treatment:internal f,IM Nailing of Humeral Shaft Fractures,上肢骨折和手外伤课件,14,IM Nailing of Humeral Shaft Fr,Plate Fixation,上肢骨折和手外伤课件,15,Plate Fixation上肢骨折和手外伤课件15,Anatomy,Supracondylar Fracture of the Humerus肱骨髁上骨折,上肢骨折和手外伤课件,16,AnatomySupracondylar Fracture,Causes,By a fall,The child may stretch out his or her hand and the force from the impact may be enough to cause a break in the bone. But any trauma to the area, such as an injury from a car accident, may also be a cause.,上肢骨折和手外伤课件,17,CausesBy a fall上肢骨折和手外伤课件17,- type I: non-displaced frx,- type II: displaced with intact posterior cortex,- type III: displaced with no cortical contact,上肢骨折和手外伤课件,18,- type I: non-displaced frx,Symptoms,pain in the elbow,swelling in the elbow,inability to move the arm due to pain,上肢骨折和手外伤课件,19,Symptomspain in the elbow 上肢骨折,Complications,compartment syndrome,Volkmanns contracture,median or ulnar nerve injury,stiffness,angulation,myositis ossificans,上肢骨折和手外伤课件,20,Complicationscompartment syndr,Treatment,Case 1,上肢骨折和手外伤课件,21,TreatmentCase 1 上肢骨折和手外伤课件21,Case 2,上肢骨折和手外伤课件,22,Case 2上肢骨折和手外伤课件22,Both bone forearm fractures前臂双骨折,上肢骨折和手外伤课件,23,Both bone forearm fractures前臂,Classification,Both Bone Forearm Fractures,Location,Proximal, middle, distal third, epiphyseal,Skin Integrity,Open, Closed,Fracture Pattern,Same level, different level, associated joint disruptionMonteggia Fractures Galeazzi Fractures,Displacement,Rotation, translation, shortening, interosseous space,Skeletal Maturity,Mature vs immature,上肢骨折和手外伤课件,24,ClassificationBoth Bone Forear,Case 1 : 42 year old man injured,in a car accident. His left arm,上肢骨折和手外伤课件,25,Case 1 : 42 year old man inju,Case 2,上肢骨折和手外伤课件,26,Case 2上肢骨折和手外伤课件26,Colles fracture,Smith fracture,Distal radius Fracture桡骨远端骨折,上肢骨折和手外伤课件,27,Colles fractureSmith fractureD,Classification of distal radius fractures,I Dorsal displaced,Colles fractures,II Palmar displaced,Smith fractures,III,Comminuted fractures,上肢骨折和手外伤课件,28,Classification of distal radiu,(1.) Distraction with external fixation supplemented with percutaneous Kirschner wires.,(2.) Distraction using a temporary plate and screws, tunnelled between two small access incisions.,(3.) Open reduction with a buttress plate.,(4.) Open reduction with the Medoff fixation system.,Fixation of distal radius fractures,上肢骨折和手外伤课件,29,(1.) Distraction with external,Complication,Reflex sympathetic dystrophy;,finger stiffness;,ulnar styloid nonunion;,Carpal tunnel syndrome; posttraumatic arthritis;,tendon rupture,carpal instability,上肢骨折和手外伤课件,30,ComplicationReflex sympathetic,Case 1,This 60 year old,woman .,She was treated with,closed reduction and,pinning.,Treatment,上肢骨折和手外伤课件,31,Case 1Treatment上肢骨折和手外伤课件31,Case 2,Preop,Postop,上肢骨折和手外伤课件,32,Case 2Preop Postop上肢骨折和手外伤课件32,The Injured Hand,手外伤,上肢骨折和手外伤课件,33,The Injured Hand上肢骨折和手外伤课件33,Arteries of hand,上肢骨折和手外伤课件,34,Arteries of hand 上肢骨折和手外伤课件34,Nerves of hand,上肢骨折和手外伤课件,35,Nerves of hand上肢骨折和手外伤课件35,Examination of the Injured Hand,At rest, fingertips normally fall into a cascade posture of increasing flexion from the index to the small finger.,上肢骨折和手外伤课件,36,Examination of the Injured Han,Flaps for fingertip reconstruction,(1.) Palmar V-Y neurovascular island advancement flap.,(2.) Dorsal cross finger flap.,(3.) Thenar flap.,上肢骨折和手外伤课件,37,Flaps for fingertip reconstruc,Tendon Injury,肌腱损伤,上肢骨折和手外伤课件,38,Tendon Injury 上肢骨折和手外伤课件38,flexor tendons,上肢骨折和手外伤课件,39,flexor tendons上肢骨折和手外伤课件39,flexor tendon zones,1: digital sheath,containing one tendon;,2: digital sheath,containing two tendons,(,no mans land,),3: palm;,4: carpal tunnel;,5: the forearm.,no mans land,上肢骨折和手外伤课件,40,flexor tendon zones1: digital,Tendon Suture,上肢骨折和手外伤课件,41,Tendon Suture上肢骨折和手外伤课件41,Scaphoid fractures 舟骨骨折,上肢骨折和手外伤课件,42,Scaphoid fractures 舟骨骨折上肢骨折和手,Xray before,two months postop,two months postop,Xray before,上肢骨折和手外伤课件,43,Xray before two months postop,Intraarticular Metacarpal base fractures关节内掌骨基底骨折,Bennetts and reversed Bennetts fractures.,上肢骨折和手外伤课件,44,Intraarticular Metacarpal base,Metacarpal Neck Fractures掌骨颈部骨折,Boxers fracture,上肢骨折和手外伤课件,45,Metacarpal Neck Fractures掌骨颈部,Phalangeal fractures指骨骨折,上肢骨折和手外伤课件,46,Phalangeal fractures指骨骨折 上肢骨折,middle phalanx base fracture,Dorsal fracture dislocation,palmar,fracture dislocation,上肢骨折和手外伤课件,47,middle phalanx base fracture D,Unicondylar phalanx head fractures 指骨头部骨折,上肢骨折和手外伤课件,48,Unicondylar phalanx head fract,上肢骨折和手外伤课件,49,上肢骨折和手外伤课件49,