上肢骨折和手外伤课件

1、Clavicle Fractures锁骨骨折Anatomy 上肢骨折和手外伤课件1Clavicle Fractures锁骨骨折AnatomyCauses of Clavicle FractureAccidents 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2Causes of Clavicle FractureAccFracture Classification Fracture of middle 1 / 3 ( group I ) account for

2、80 %上肢骨折和手外伤课件3Fracture Classification Fractufrx 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4frx of distal 1/3 (group II) Sympt

3、oms of Clavicle FracturePain 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5Symptoms of Clavicle FracturePTreatment of Clavicle Fracture The goal of treating broken bones is to set them, making

4、them whole againfigure-8 splint or strap immobilized for 6-8 weeksOpen reduction and internal fixation上肢骨折和手外伤课件6Treatment of Clavicle FractureHumerus Shaft Fractures 肱骨干骨折上肢骨折和手外伤课件7Humerus Shaft Fractures 肱骨干骨折Causes of Humeral Shaft Fracture Direct stress, such as a blow to the arm. Indirect forc

5、es,such as a fall,twisting or torsional forces. 上肢骨折和手外伤课件8Causes of Humeral Shaft Fractumechanismbending 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

6、 will frx either proximal or distal ends of humerus;上肢骨折和手外伤课件9mechanismbending force producetypes of humeral shaft fracture Transverse humeral fractures Short oblique fractures Long spiral fractures上肢骨折和手外伤课件10types of humeral shaft fracturSymptoms of humeral shaft fracturePain Loss of strength in

7、the gripSwell DeformityTenderness 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11Symptoms of humeral shaft fracNon Operative Treatment of Humeral Shaft fractureLong arm splint needs to be applied from shoulder to wrist to fully immobilize the extr

8、emity;上肢骨折和手外伤课件12Non Operative Treatment of HumOperative 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13Operative Treatment:internal fIM Nailing of Humeral Shaft Fractures上肢骨折和手外伤课件14IM Nailing of Humeral Shaft FrP

9、late Fixation上肢骨折和手外伤课件15Plate Fixation上肢骨折和手外伤课件15AnatomySupracondylar Fracture of the Humerus肱骨髁上骨折上肢骨折和手外伤课件16AnatomySupracondylar Fracture CausesBy a fallThe 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

10、, such as an injury from a car accident, may also be a cause. 上肢骨折和手外伤课件17CausesBy 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 Symptomspain in the elbow swelling

11、 in the elbow inability to move the arm due to pain 上肢骨折和手外伤课件19Symptomspain in the elbow 上肢骨折Complicationscompartment syndromeVolkmanns contracturemedian or ulnar nerve injurystiffnessangulationmyositis ossificans上肢骨折和手外伤课件20Complicationscompartment syndrTreatmentCase 1 上肢骨折和手外伤课件21TreatmentCase 1

12、上肢骨折和手外伤课件21Case 2上肢骨折和手外伤课件22Case 2上肢骨折和手外伤课件22Both bone forearm fractures前臂双骨折上肢骨折和手外伤课件23Both bone forearm fractures前臂ClassificationBoth Bone Forearm FracturesLocationProximal, middle, distal third, epiphysealSkin IntegrityOpen, ClosedFracture PatternSame level, different level, associated joint

13、disruptionMonteggia Fractures Galeazzi Fractures DisplacementRotation, translation, shortening, interosseous spaceSkeletal MaturityMature vs immature上肢骨折和手外伤课件24ClassificationBoth Bone ForearCase 1 : 42 year old man injured in a car accident. His left arm 上肢骨折和手外伤课件25Case 1 : 42 year old man injuCas

14、e 2上肢骨折和手外伤课件26Case 2上肢骨折和手外伤课件26Colles fractureSmith fractureDistal radius Fracture桡骨远端骨折上肢骨折和手外伤课件27Colles fractureSmith fractureDClassification of distal radius fracturesI Dorsal displacedColles fracturesII Palmar displacedSmith fracturesIIIComminuted fractures上肢骨折和手外伤课件28Classification of distal

15、 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

16、 distal radius fractures 上肢骨折和手外伤课件29(1.) Distraction with externalComplicationReflex 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30ComplicationReflex sympatheticCase 1This 60 year oldwoma

17、n .She was treated with closed reduction and pinning. Treatment上肢骨折和手外伤课件31Case 1Treatment上肢骨折和手外伤课件31Case 2Preop Postop上肢骨折和手外伤课件32Case 2Preop Postop上肢骨折和手外伤课件32The Injured Hand手外伤 上肢骨折和手外伤课件33The Injured Hand上肢骨折和手外伤课件33Arteries of hand 上肢骨折和手外伤课件34Arteries of hand 上肢骨折和手外伤课件34Nerves of hand上肢骨折和手

18、外伤课件35Nerves of hand上肢骨折和手外伤课件35Examination of the Injured HandAt 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36Examination of the Injured HanFlaps for fingertip reconstruction (1.) Palmar V-Y neurovascular island advancem

19、ent flap. (2.) Dorsal cross finger flap. (3.) Thenar flap. 上肢骨折和手外伤课件37Flaps for fingertip reconstrucTendon Injury 肌腱损伤 上肢骨折和手外伤课件38Tendon Injury 上肢骨折和手外伤课件38flexor tendons上肢骨折和手外伤课件39flexor tendons上肢骨折和手外伤课件39flexor tendon zones1: 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40flexor tendon zones1: digital Tendon Suture上肢骨折和手外伤课件41Tendon Suture上肢骨折和手外伤课件41Scaphoid fractures 舟骨骨折上肢骨折和手外伤课件