骨折概论outline of fracture

1、12The definition of fracture Classification of fractureCause of fracture The fragment displacement of fracture Section 1：3 Definition ： The break off of bone integrality or continuity fracture cause： direct trauma indirect trauma accumulated forcefatigue fracture the bone preexistingthe bone preexis

2、tingdisease disease Pathologic fracturesPathologic fractures4 A pathologic fracture is one in which a bone is broken through an area weakened by preexisting disease, by a degree of stress that would have left a normal bone intact.5根据骨折处皮肤粘膜的完整性分类根据骨折处皮肤粘膜的完整性分类 closed fracture open fracture communic

3、ated with bladder、rectum -sacrum 、coccyx6(二二) The classification according to the extent or morphologic characteristic of fractures fissure fracture fissure fracture Greenstick fractureGreenstick fractureTransverse Transverse Oblique ObliqueSpiral Spiral Comminuted Comminuted Impacted Impacted Compr

4、ession Compression separation of epiphysis(epiphysiolysisseparation of epiphysis(epiphysiolysis) ) (8)Depressed (8)Depressed 7 Stable fractureStable fracture： It is not easy to take place displacement after reduction. Such as Transverse Impacted Unstable fracture Unstable fracture ： It is easy to ta

5、ke place displacement after reduction. Such as Comminuted Oblique8 Trauma effect The weight of distal part of limb The muscle contract The mistake during transportation and pretreatment 9in most cases the deformity is the combination of several displacement 1011、shock in the cases of severe fracture

6、 due to bleeding、internal organ trauma、severe pain 、intensive stress reaction、fever generally 38 C haematoma absorption, infection during open fracture 121. common features of fracture pain、swelling 、loss of function 2. special feasures of fracture 、deformity 、abnormal mobility 、bony crepitus 骨擦音骨擦音

7、(感感)13ultimately, the proof is the radiographic demonstration of a fracture，The x-ray films should include the joints at each end of the bone. AP and lateral view 。A few slight fissure fracture should accept X ray Exa. again in 2 weeks to make sure the diagnosis.possess the inestimable benefit in so

8、me special cases1415161718weakness，pain, tension fibrosis cant be reverse 19坠积性肺炎坠积性肺炎 contradictory -balance20 fracture of wrist scaphoid bone 舟骨21 Section 4：The processing of bone healing periosteum22232425no deformation for observation 2 Weeks26Section 5：The factors of influencing the fracture he

9、aling 、 Age:Age: children，adultsadults 2 2、 Health conditions: pantatrophia(全全身营养不良身营养不良), diabetes, metabolic disease 27 281. Repeated manipulative reduction2. Open reduction：widespread decoherence3. Open fracture unsuitable debridement removing bone cips （碎骨片）（碎骨片）4. Over traction 5. Poor fixation

10、6. Unsuitable exercisesThe influence of therapeutic methods ：29Section 6: first aid of fracture 、handling shock: severe multiple trauma，Aspiratory Blood pressure Circulation 、bandaging wound 、fixation： a.avoid the injury nerve and vessel b.reducing pain and prevention of shock c.easy to transportati

11、on 4、fast transportation 30 ！Reduction, ！Fixation, ！Exercise Reduction ：manipulation or operationFixation ： internal, external or combination of bothExercise ： isometric contraction, isotonic contraction311. Anatomical reduction：2. Functional reduction：A. The standard：The displacement of rotational

12、and isolation must be corrected B. Shorten： lower limbs 1cm，chdren1/332331) indication ：A. intercalation of soft tissue，failure of manipulative reductionB.intraarticular fracture with poor manipulative reductionC. not achieving functional reduction after manipulationD. complicating never and vessel

13、damage E.multiple fracture easy nursing and reducing complication1342) The advantage and disadvantage of 0pen reductionAdvantage：anatomical reduction , stable fixation ，early functional exercise。Disadvantage:i.Affecting of blood supply because peel off soft tissue ii.Increasing local soft tissue inj

14、ury , infection iii. Some complication related with internal fixation device and need second operation to remove the device35363738continuous traction 3940 (二二)The internal fixation of fracture41424344Exercise：The principle: combination of activeness and passiveness , dynamic and static combination step by step 45、early period 6h and Type III not internal fixation 2. Vital soft tissue repairing: vessel, nerve, tendon 3. Draining of wound:51 most type I, II can closing wound directly ，type III should handling the wound according to the condit