外科学教学课件：上肢骨折 (3)

1、Fracture of Upper Extremities,Section II,Supracondylar Fractures of Humerus Fracture of shaft of radius and ulna Fracture of distal end of radius,Section II,Supracondylar Fractures of Humerus,Epidemiology,A fracture of the distal humerus just above the epicondyles. More common factures to occur in c

2、hildren. The peak incidence is between the ages of 5-8 years of age Often associated with the development of serious complications,Distal Humerus Anatomy,Medial epicondyle proximal to trochlea （滑车） Lateral epicondyle proximal to capitellum（肱骨小头） Radial fossa accommodates margin of radial head during

3、 flexion Coronoid fossa accepts coronoid process of ulna during flexion,Anatomy,Forward tilt angle:30-50,Axis of Humerus shaft and Axis of Humeral condylar,Anatomy,桡神经,正中神经,尺神经,Classification,伸直型,屈曲型,Extension type,Fall on outstretched hand 95,Extension type,Anterior interosseous nerve injury (正中神经的

4、分支,Radial nerve（桡神经） Weekness in wrist and fingers extension,Brachial artery,Brachial artery injury（肱动脉损伤） Osteofascial Compartment Syndrome（骨筋膜室综合征,Extension type,Flexion type,Fall directly on the flexed elbow 5,Flexion type,Ular nerve injury 尺神经损伤,Clinical features,History of truma Swelling Pain D

5、eformity Ecchymosis,kmoss 瘀斑 Disfunction of elbow,Physical Examination Careful neurovascluar examination of the arm is essential. Brachial artery may be lacerated by the proximal fracture fragment , either at the time of injury or during reduction, Osteofascial compartment syndrome may be developed.

6、 Radial and median nerves are the most commonly affected in extension type Ular nerve is commonly affected in flexion type,Radiographic evaluation,X-ray: Roentgenogram may identify the site of the damage , displacement of fragment, type of fractures and degree of comminuting,Extension type,Flexion t

7、ype,Treatment,Nonoperative treatment Closed reduction,immobilization with arm splint ,maintaining elbow joint flexing about 80 degree for 46 weeks,Self-study 自学,伸直型,屈曲型,Operative treatment,Choice of implants Crossed screws or crossed pins can be used successfully （mostly） Reconstructive plates and s

8、crews,Open reduction and internal fixation Indication: closed reduction fail open fracture neurovascular injuries,Open reduction and internal fixation,Section II-Part I,Part I: Fractures of shaft of radius and ulna,Two bones There is a interosseous membrane between the bones Five joints: radiohumera

9、l, ulnohumeral, proximal radioulnar, radiocarpal and distal radioulnar joints. These joints make it possible for the radius to rotate by rolling over the ulnar,Anatomy of forearm,Mechanism,With a direct blow you can break either isolated, however more likely indirect blow to damage both,Pain,crepitu

10、s,swelling secondary to fracture hematoma and soft-tissue injury. Apparent deformity:results from the high energy and the multitude of deforming muscle force. Skin:should be throughly inspected for any breaks that may communicate with fracture,Clinical features,More severe swelling Tense forearm com

11、partments Pain out of proportion to the injury Pain with passive extension of fingers Any signs of compartment syndrome warrants immediate fasciotomy,Compilcation-compartment syndrome,Radiographic evaluation,Direct force,X ray,Two special fractures of forearm Monteggia fracture Galeazzi fracture,Mon

12、teggia,Monteggia fracture: proximal 1/3 fracture of ulnar associated with radial head dislocation,Galeazzi,Galeazzi fracture: distal 1/3 fracture of radial shaft associated with distal radioulnar joint dislocation,Treatment,Open reduction and internal fixation： Compression plate and screws Intramedu

13、llary fixation,Compression plate and screws,Segmental fractures of diaphysis of forearm,Intramedullary fixation,Fracture of distal end of radius,Most commonly women age 60-70. 90% caused by compression on dorsiflexed wrist. 90% of distal radius fractures are Colles Fractures,Fracture of distal end o

14、f radius,Definition Fracture is within 3cm of the distal articular surface of radius,Anatomy,掌倾角,尺偏角,1-1.5cm,Classification based on the mechanism of injury Extension type fracture (Colles) Flexion type fracture (Simith) Fracture-dislocation （Barton,Classification,Mechanism of injury The fracture oc

15、curs from a fall on extended arm and on the palm of hand with forearm pronation,Extenion type-Colles fracture,骨折远端的移位方向：dorsal and radial（背、桡侧移位,Pain,crepitus,swelling,dysfunction of wrist. Deformity Lateral view: dinner fork deformity（银叉样畸形） Anteroposterior view: rifle bayonet deformity（枪刺样畸形,Clinical features,Radiographic evaluation,Colles,Normal,X-ray,Colles,Normal,External Fixation,Open reduction and internal fixation,Mechanism of injury The fracture occurs from a blow on the dorsum of wrist,Flexion type-simith fracture,骨折远端的移位方向：掌、桡侧移位,ORIF-Volar Bartons Fractures,