上肢骨折和手外伤

ClavicleFractures

锁骨骨折Anatomy第一页，共五十页。CausesofClavicleFractureAccidentssuchasfalls

Sometimes,ablowfromabluntobjectoracollisionofsomesort第二页，共五十页。FractureClassificationFractureofmiddle1/3(groupI)

accountfor80%第三页，共五十页。frxofdistal1/3(groupII)

accountfor10-15%

typeI:minimaldisplacement

typeII:frxmedialtocoracoclavicularligaments

typeIII:articularsurfacefractures

frxofmedial1/3(groupIII)accountfor5%第四页，共五十页。SymptomsofClavicleFracturePainSwellingTendernessDeformityInternalbleedingIfaskedtolifttheirarm,patientswithabrokenclaviclecannotdosowithoutextremepain.第五页，共五十页。TreatmentofClavicleFracture

Thegoaloftreatingbrokenbonesistosetthem,makingthemwholeagainfigure-8splintorstrapimmobilizedfor6-8weeksOpenreductionandinternalfixation第六页，共五十页。HumerusShaftFractures

肱骨干骨折第七页，共五十页。CausesofHumeralShaftFractureDirectstress,suchasablowtothearm.Indirectforces,suchasafall,twistingortorsionalforces.

第八页，共五十页。mechanismbendingforceproducestransversefrxoftheshaft;torsionforcewillresultinaspiralfracture;combinationofbendingandtorsionproduceobliquefrxw/orw/oabutterflyfragment;compressionforceswillfrxeitherproximalordistalendsofhumerus;

第九页，共五十页。typesofhumeralshaftfractureTransversehumeralfracturesShortobliquefracturesLongspiralfractures第十页，共五十页。SymptomsofhumeralshaftfracturePainLossofstrengthinthegripSwellDeformityTenderness

Ifthebloodsupplyisimpaired,theremaybenumbnessandcoldnessinthearmandhand.第十一页，共五十页。NonOperativeTreatmentofHumeralShaftfractureLongarmsplintneedstobeappliedfromshouldertowristtofullyimmobilizetheextremity;第十二页，共五十页。OperativeTreatment:internalfixationshouldbereservedforfractureswithinadequatereductionorpatientswithmultipletrauma;第十三页，共五十页。IMNailingofHumeralShaftFractures第十四页，共五十页。PlateFixation第十五页，共五十页。AnatomySupracondylarFracture

oftheHumerus

肱骨髁上骨折第十六页，共五十页。CausesByafall

Thechildmaystretchouthisorherhandandtheforcefromtheimpactmaybeenoughtocauseabreakinthebone.

Butanytraumatothearea,suchasaninjuryfromacaraccident,mayalsobeacause.

第十七页，共五十页。-typeI:non-displacedfrx-typeII:displacedwithintactposteriorcortex-typeIII:displacedwithnocorticalcontact第十八页，共五十页。Symptomspainintheelbowswellingintheelbowinabilitytomovethearmduetopain第十九页，共五十页。ComplicationscompartmentsyndromeVolkmann‘scontracturemedianorulnarnerveinjurystiffnessangulationmyositisossificans第二十页，共五十页。TreatmentCase1第二十一页，共五十页。Case2第二十二页，共五十页。Bothboneforearmfractures

前臂双骨折第二十三页，共五十页。ClassificationBothBoneForearmFracturesLocationProximal,middle,distalthird,epiphysealSkinIntegrityOpen,ClosedFracturePatternSamelevel,differentlevel,associatedjointdisruption

MonteggiaFractures

GaleazziFracturesDisplacementRotation,translation,shortening,interosseousspaceSkeletalMaturityMaturevsimmature第二十四页，共五十页。Case1:42yearoldmaninjuredinacaraccident.Hisleftarm第二十五页，共五十页。Case2第二十六页，共五十页。CollesfractureSmithfractureDistalradiusFracture

桡骨远端骨折第二十七页，共五十页。ClassificationofdistalradiusfracturesIDorsaldisplacedCollesfracturesIIPalmardisplacedSmithfracturesIIIComminutedfractures第二十八页，共五十页。(1.)DistractionwithexternalfixationsupplementedwithpercutaneousKirschnerwires.(2.)Distractionusingatemporaryplateandscrews,tunnelledbetweentwosmallaccessincisions.(3.)Openreductionwithabuttressplate.(4.)OpenreductionwiththeMedofffixationsystem.Fixationofdistalradiusfractures第二十九页，共五十页。ComplicationReflexsympatheticdystrophy;fingerstiffness;ulnarstyloidnonunion;Carpaltunnelsyndrome;posttraumaticarthritis;tendonrupturecarpalinstability第三十页，共五十页。Case1This60yearoldwoman.Shewastreatedwithclosedreductionandpinning.Treatment第三十一页，共五十页。Case2PreopPostop第三十二页，共五十页。TheInjuredHand手外伤第三十三页，共五十页。Arteriesofhand第三十四页，共五十页。Nervesofhand第三十五页，共五十页。ExaminationoftheInjuredHandAtrest,fingertipsnormallyfallintoacascadepostureofincreasingflexionfromtheindextothesmallfinger.第三十六页，共五十页。Flapsforfingertipreconstruction(1.)PalmarV-Yneurovascularislandadvancementflap.(2.)Dorsalcrossfingerflap.(3.)Thenarflap.

第三十七页，共五十页。TendonInjury肌腱损伤第三十八页，共五十页。flexortendons第三十九页，共五十页。flexortendonzones1:digitalsheathcontainingonetendon;2:digitalsheathcontainingtwotendons("noman'sland")3:palm;4:carpaltunnel;5:theforearm."noman'sland"第四十页，共五十页。TendonSuture第四十一页，共五十页。Scaphoidfractures

舟骨骨折第四十二页，共五十页。XraybeforetwomonthspostoptwomonthspostopXraybefore第四十三页，共五十页。IntraarticularMetacarpalbasefractures

关节内掌骨基底骨折Bennett'sandreversedBennett'sfractures.第四十四页，共五十页。MetacarpalNeckFractures

掌骨颈部骨折Boxer'sfracture

第四十五页，共五十页。Phalangealfractures

指骨骨折第四十六页，共五十页。middlephalanxbasefractureDorsalfracturedislocation

palmarfracturedislocation

第四十七页，共五十页。Unicondylarphalanxheadfractures

指骨头部骨折第四十八页，共五十页。第四十九页，共五十页。内容梗概ClavicleFractures

锁骨骨折。HumerusShaftFractures

肱骨干骨折。Byafall。Bothboneforearmfractures

前臂双骨折。DistalradiusFracture

桡骨远端骨折。clos