上肢骨折和手外伤

ClavicleFractures

锁骨骨折Anatomy第1页，共50页。CausesofClavicleFractureAccidentssuchasfalls

Sometimes,ablowfromabluntobjectoracollisionofsomesort第2页，共50页。FractureClassificationFractureofmiddle1/3(groupI)

accountfor80%第3页，共50页。frxofdistal1/3(groupII)

accountfor10-15%

typeI:minimaldisplacement

typeII:frxmedialtocoracoclavicularligaments

typeIII:articularsurfacefractures

frxofmedial1/3(groupIII)accountfor5%第4页，共50页。SymptomsofClavicleFracturePainSwellingTendernessDeformityInternalbleedingIfaskedtolifttheirarm,patientswithabrokenclaviclecannotdosowithoutextremepain.第5页，共50页。TreatmentofClavicleFracture

Thegoaloftreatingbrokenbonesistosetthem,makingthemwholeagainfigure-8splintorstrapimmobilizedfor6-8weeksOpenreductionandinternalfixation第6页，共50页。HumerusShaftFractures

肱骨干骨折第7页，共50页。CausesofHumeralShaftFractureDirectstress,suchasablowtothearm.Indirectforces,suchasafall,twistingortorsionalforces.

第8页，共50页。mechanismbendingforceproducestransversefrxoftheshaft;torsionforcewillresultinaspiralfracture;combinationofbendingandtorsionproduceobliquefrxw/orw/oabutterflyfragment;compressionforceswillfrxeitherproximalordistalendsofhumerus;

第9页，共50页。typesofhumeralshaftfractureTransversehumeralfracturesShortobliquefracturesLongspiralfractures第10页，共50页。SymptomsofhumeralshaftfracturePainLossofstrengthinthegripSwellDeformityTenderness

Ifthebloodsupplyisimpaired,theremaybenumbnessandcoldnessinthearmandhand.第11页，共50页。NonOperativeTreatmentofHumeralShaftfractureLongarmsplintneedstobeappliedfromshouldertowristtofullyimmobilizetheextremity;第12页，共50页。OperativeTreatment:internalfixationshouldbereservedforfractureswithinadequatereductionorpatientswithmultipletrauma;第13页，共50页。IMNailingofHumeralShaftFractures第14页，共50页。PlateFixation第15页，共50页。AnatomySupracondylarFracture

oftheHumerus

肱骨髁上骨折第16页，共50页。CausesByafall

Thechildmaystretchouthisorherhandandtheforcefromtheimpactmaybeenoughtocauseabreakinthebone.

Butanytraumatothearea,suchasaninjuryfromacaraccident,mayalsobeacause.

第17页，共50页。-typeI:non-displacedfrx-typeII:displacedwithintactposteriorcortex-typeIII:displacedwithnocorticalcontact第18页，共50页。Symptomspainintheelbowswellingintheelbowinabilitytomovethearmduetopain第19页，共50页。ComplicationscompartmentsyndromeVolkmann‘scontracturemedianorulnarnerveinjurystiffnessangulationmyositisossificans第20页，共50页。TreatmentCase1第21页，共50页。Case2第22页，共50页。Bothboneforearmfractures

前臂双骨折第23页，共50页。ClassificationBothBoneForearmFracturesLocationProximal,middle,distalthird,epiphysealSkinIntegrityOpen,ClosedFracturePatternSamelevel,differentlevel,associatedjointdisruption

MonteggiaFractures

GaleazziFracturesDisplacementRotation,translation,shortening,interosseousspaceSkeletalMaturityMaturevsimmature第24页，共50页。Case1:42yearoldmaninjuredinacaraccident.Hisleftarm第25页，共50页。Case2第26页，共50页。CollesfractureSmithfractureDistalradiusFracture

桡骨远端骨折第27页，共50页。ClassificationofdistalradiusfracturesIDorsaldisplacedCollesfracturesIIPalmardisplacedSmithfracturesIIIComminutedfractures第28页，共50页。(1.)DistractionwithexternalfixationsupplementedwithpercutaneousKirschnerwires.(2.)Distractionusingatemporaryplateandscrews,tunnelledbetweentwosmallaccessincisions.(3.)Openreductionwithabuttressplate.(4.)OpenreductionwiththeMedofffixationsystem.Fixationofdistalradiusfractures第29页，共50页。ComplicationReflexsympatheticdystrophy;fingerstiffness;ulnarstyloidnonunion;Carpaltunnelsyndrome;posttraumaticarthritis;tendonrupturecarpalinstability第30页，共50页。Case1This60yearoldwoman.Shewastreatedwithclosedreductionandpinning.Treatment第31页，共50页。Case2PreopPostop第32页，共50页。TheInjuredHand手外伤第33页，共50页。Arteriesofhand第34页，共50页。Nervesofhand第35页，共50页。ExaminationoftheInjuredHandAtrest,fingertipsnormallyfallintoacascadepostureofincreasingflexionfromtheindextothesmallfinger.第36页，共50页。Flapsforfingertipreconstruction(1.)PalmarV-Yneurovascularislandadvancementflap.(2.)Dorsalcrossfingerflap.(3.)Thenarflap.

第37页，共50页。TendonInjury肌腱损伤第38页，共50页。flexortendons第39页，共50页。flexortendonzones1:digitalsheathcontainingonetendon;2:digitalsheathcontainingtwotendons("noman'sland")3:palm;4:carpaltunnel;5:theforearm."noman'sland"第40页，共50页。TendonSuture第41页，共50页。Scaphoidfractures

舟骨骨折第42页，共50页。XraybeforetwomonthspostoptwomonthspostopXraybefore第43页，共50页。IntraarticularMetacarpalbasefractures

关节内掌骨基底骨折Bennett'sandreversedBennett'sfractures.第44页，共50页。MetacarpalNeckFractures

掌骨颈部骨折Boxer'sfracture

第45页，共50页。Phalangealfractures

指骨骨折第46页，共50页。middlephalanxbasefractureDorsalfracturedislocation

palmarfracturedislocation

第47页，共50页。Unicondylarphalanxheadfractures

指骨头部骨折第48页，共50页。第49页，共50页。内容梗概ClavicleFractures

锁骨骨折。Byafall。Bothboneforearmfractures

前臂双骨折。DistalradiusFracture

桡骨远端骨折。closed