外科2骨折总论

1、 Anatomic reductionFunctional reduction 1. Rotation and separation must be corrected completely 2. The shortening of lower limb should be less than 1cm in adults and 2 cm in children 3. Slight angulations without sideways 4. At least 1/3 contact of cross section in diaphysis and 3/4 in metaphysis Ad

2、vantages Good reduction Stable immobilization Early exercises Disadvantages Destroy the blood supplyInfection Delayed unionFailure of the implantReoperation for implant removal External fixation small wood splints，plaster，abduction brace，traction，external fixator Internal fixation plate and screw，na

3、ilInternal fixation plate and screw，nailAO Principles of ORIF 1963 Atraumatic surgical technique Anatomical reduction of fracture Stable internal fixation Early active pain free mobilization Anatomic reduction Fracture reduction and fixation to restore functional anatomical relationships Stable fixa

4、tion Stability by rigid fixation or splintage, as the personality of the fracture and the injury requires Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques Early mobilization Early and safe mobilization of the pa

5、rt and patientIndirect reduction methodsLimited exposureLow elastic modulus,biocompatible materialsLimited contact between bone and implantLimited time of operationMinimally Invasive Percutaneous Plate Osteosynthesis（Less Invasive Stabilization System )1.Regular surgical steps 2.Specialized implanta

6、tion and insrtumentation “No-touch Plate”经皮肤微创经皮肤微创接骨术接骨术Minimally Invasive Percutaneous Plate Osteosynthesis Reconstruction of the articular surface Bridging plate Correction of length, rotation and axial alignment of the main shaft fragmentsIndirect reductionLimited exposurePreservation of the blo

7、od supply to soft tissue and bone 2 Options Interlocking nails LISS A minimally invasive procedure (MIP) is any procedure (surgical or otherwise) that is less invasive than open surgery used for the same purpose. small incision less operative trauma less pain and scarring shorter operative time less

8、 infection quicker recovery time shorter hospital stays. The Complication of Fractures Early complication Shock Infection Visceral injuries spleen，lung，bladder，rectum Injury of peripheral tissue arteries，nerves，spinal cord Fat embolism compartment syndromeHolstein-Lewis fractureHolstein-Lewis fractu

9、reHolstein-Lewis fracture Delayed union A fracture that requires more time than usual to healNonunion A fracture that is a minimum of 9 months post occurrence and is not healed and has not shown radiographic progression for 3 months(FDA 1986)Malunion A fracture that has healed with the fragments in

10、a nonanatomical position.Host factorsFracture/Injury factorsInitial treatment of injury factors (Iatrogenic)Complicating factor (Infection)elephant foothorse hoofnecroticdefectatrophichypertrophic/vitalavital?avitalVascularizedAvascularTreatmentNonoperativeOperativeStabilizationEnhancement of biolog

11、yEradication of infection PrinceplesMethods Electrical stimulation Ultrasound Extracorporeal shock wave therapy Debridement and hardware removal Plate osteosynthesis Intramedullary nailing External fixationAutogenous bone graftBone marrow aspirateAllograft boneDemineralized bone matrixBMPPlatelet co

12、ncentrates CoCompartment syndrome a life-threatening condition of the limbs which occurs after an injury, when there is insufficient blood supply to muscles and nerves due to increased pressure within one of the bodys compartments, such as an arm, leg or other enclosed space within the body. CausesT

13、he fascia layer that defines the compartment does not stretch Any condition that results in an increase in compartment contents or reduction in a compartments volume Common causes of compartment syndrome include tibial or forearm fractures ischemic reperfusion, hemorrhage, vascular puncture, intravenous drug injection, casts, prolonged limb compression, crush injuries and burns. Pathophysiology of compartment syndrome Elevated pressure Compromised capillary blood flow (ischemia) Edema of the soft tissueFurther raised pressureCompromised veno