上肢骨折与关节损伤吕海

UpperLimbIncludeClavicle锁骨Scapula肩胛骨ShoulderJoint肩关节Humerus肱骨ElbowJoint肘关节RadiusandUlna尺桡骨WristJoint腕关节ScaphoidBone舟状骨当前第1页\共有63页\编于星期四\15点Mechanism损伤机制MostlyIndirectCommonlydescribedas“afallonoutstretchedhand“Typeofinjurydependsonpositionoftheupperlimbatthetimeofimpact:Flexed屈曲,Extended伸直,Adducted内收,Abducted外展,Pronated旋前orSupinated旋后当前第2页\共有63页\编于星期四\15点FractureoftheClavicle锁骨骨折CommonespeciallyinchildrenandelderlyCommonestsiteisthemiddleonethirdMainlyduetoindirectinjuryDirectinjuryleadstocomminutedfracture当前第3页\共有63页\编于星期四\15点当前第4页\共有63页\编于星期四\15点TreatmentConservativebyanarmsling手臂吊带oreightbandage八字绷带Operativefixationisindicatedifthereisanopenfracture,neurovascularinjuryornonunion当前第5页\共有63页\编于星期四\15点FigureofeightBandage8字固定带当前第6页\共有63页\编于星期四\15点AcromioClavicularJ

Disloc

肩锁关节脱位I型：关节囊、韧带未断裂II型：关节囊破裂III型：关节囊、韧带完全断裂HookPlate钩钢板当前第7页\共有63页\编于星期四\15点DislocationoftheShoulder肩关节脱位MostlyAnterior>95%ofdislocationsPosteriorDislocationoccurs<5%TrueInferiordislocation(luxatioerecta直举性肱骨脱位)occurs<1% Habitual

习惯性脱位NontraumaticdislocationmaypresentasMultidirectionaldislocationduetogeneralizedligamentouslaxityandisPainless

Inferior当前第8页\共有63页\编于星期四\15点Mechanism机制UsuallyIndirectfallonAbductedandextendedshoulderMaybedirectwhenthereisablowontheshoulderfrombehind当前第9页\共有63页\编于星期四\15点AnteriorShoulderdislocationUsuallyalsoinferiorBankart’sLesion前盂唇损伤当前第10页\共有63页\编于星期四\15点ClinicalPicturePatientisinpainHoldstheinjuredlimbwithotherhandclosetothetrunkTheshoulderisabductedandtheelbowiskeptflexedThereislossofthenormalcontour轮廓oftheshoulder当前第11页\共有63页\编于星期四\15点ClinicalPictureLossofthecontouroftheshouldermayappearasastepAnteriorbulge膨胀ofheadofhumerusmaybevisibleorpalpableAgapcanbepalpatedabovethedislocatedheadofthehumerus当前第12页\共有63页\编于星期四\15点XRayofDislocationofShoulder

当前第13页\共有63页\编于星期四\15点AssociatedInjuriesofShoulderDislocationInjurytotheneurovascularbundleinaxilla(rare)Injuryof

theAxillary腋神经(Usuallystretchingleadingtotemporaryneuropraxia)Associatedfracture当前第14页\共有63页\编于星期四\15点AxillaryNerveInjury腋神经伤AlsocalledcircumflexnerveItisabranchfromposteriorcordofBrachialplexusIthookscloseroundneckofhumerusfromposteriortoanteriorItpiercesthedeepsurfaceofdeltoid三角肌andsupplyitandthepartofskinoverit当前第15页\共有63页\编于星期四\15点ManagementofShoulderDislocationIsanEmergencyItshouldbereducedinlessthan24hoursortheremaybeAvascularNecrosisofheadofhumerusFollowingreductiontheshouldershouldbeimmobilisedstrappedtothetrunkfor3-4weeksandrestedinacollarandcuff当前第16页\共有63页\编于星期四\15点MethodsofReductionHippocratesMethod(Anesthesia麻醉isrequired)Stimpson’stechnique(Sedation镇静andAnalgesia止痛areused,butNoanesthesia)Kocher’stechniqueisthemethodusedinhospitalsundergeneralanesthesiaandmusclerelaxation当前第17页\共有63页\编于星期四\15点HippocratesMethod当前第18页\共有63页\编于星期四\15点Stimpson’stechnique当前第19页\共有63页\编于星期四\15点Kocher’sTechnique当前第20页\共有63页\编于星期四\15点ComplicationsofShoulderDislocation:EarlyNeurovascularinjury(rare)AxillarynerveinjuryAssociatedFractureofneckofhumerusorgreaterorlessertuberosities（肱骨结节）当前第21页\共有63页\编于星期四\15点ComplicationsofShoulderDislocation:LateAvascularnecrosisoftheheadoftheHumerus(highriskwithdelayedreduction)Heterotopiccalcification(usedtobecalledMyositisOssificans)骨化性肌炎Recurrentdislocation当前第22页\共有63页\编于星期四\15点FracturesofTheHumerusProximalHumerus:surgicalandanatomicalneckShaftofHumerusDistalhumerus当前第23页\共有63页\编于星期四\15点FracturesofTheHumerus当前第24页\共有63页\编于星期四\15点FractureProximalHumerus当前第25页\共有63页\编于星期四\15点Intra-medullaryKwirefixation当前第26页\共有63页\编于星期四\15点FracturesShaftoftheHumerusCommonlyIndirectIndirectinjuryresultsinSpiralorObliquefracturesDirectinjuriesresultsintransverseorcomminutedfractureMaybeassociatedwithRadialNerveinjury当前第27页\共有63页\编于星期四\15点FractureshaftoftheHumerus当前第28页\共有63页\编于星期四\15点Treatment:PlatingorNail当前第29页\共有63页\编于星期四\15点FractureDistaloftheHumerus当前第30页\共有63页\编于星期四\15点RadialNerveInjuryResultsinWristdropAssociatedwithfracture

humerusinupto12%offractures2/3(8%)ofRadialinjuryareNeuropraxia(神经失用)当前第31页\共有63页\编于星期四\15点ManagementofRadialNerveInjuryWhenpresentinopenfractures;immediateexplorationand±repairInclosedinjuriestreatedconservatively;initialmanagementisdoingNerveConductionStudies(NCS)andElectromyography(EMG)andawaitingforspontaneousrecovery当前第32页\共有63页\编于星期四\15点ManagementofRadialNerveinjuryRecoveryusuallystartsafterfewdaysbutmaytakeupto9monthsforfullrecoveryIfNospontaneousrecoveryoccursin12weeksconfirmedbyNCSandEMG;thenexplorationofthenerveshouldbecarriedout当前第33页\共有63页\编于星期四\15点ManagementofHumerusShaftFractureMostofthetimeisConservativeClosedReductioninuprightpositionfollowedbyapplicationofUshapedSlaborCylindercastFewweekslaterorinitiallyinstablefracturesFunctionalBracemaybeused当前第34页\共有63页\编于星期四\15点UShapedSlabofPOP当前第35页\共有63页\编于星期四\15点FunctionalBrace功能支具当前第36页\共有63页\编于星期四\15点IndicationsforORIF切开复位内固定Failuretoreducefractureconservatively保守失败Bilateralhumeralfractures双侧骨折OpenfracturewithradialnerveInjury开放骨折并神经伤Unconsciouspatient昏迷病人Delayed-Union延迟愈合Non-Union不愈合Mal-Union畸形愈合当前第37页\共有63页\编于星期四\15点ORIF：openreduction

internalfixation当前第38页\共有63页\编于星期四\15点Supra-condylarFractureofHumerus肱骨髁上骨折当前第39页\共有63页\编于星期四\15点PediatricSupra-CondylarHumeralFracture当前第40页\共有63页\编于星期四\15点PediatricSupra-condylarfracture当前第41页\共有63页\编于星期四\15点Reductionofsupra-condylarFractureAbsoluteEmergencyShouldbedonebyexperienceddoctorassoonaspossibleInthepastthearmwasheldinflexedelbowpositioninback-slabPOPafterreductionAtpresenttimePercutaneousKwirefixationisALWAYS

carriedoutafterreduction当前第42页\共有63页\编于星期四\15点ComplicationsSupra-CondylarFracturesEarly=Compartmentsyndrome（Volkmann‘sIschemia）

Late=Stiffness

Volkmann'sIschemicHeterotopicCalcification

Mal-Union(Valgusorvarus)当前第43页\共有63页\编于星期四\15点Supracondylarfracture当前第44页\共有63页\编于星期四\15点EblowDislocation肘关节脱位FootballWeightlifting当前第45页\共有63页\编于星期四\15点ElbowReduction肘关节复位.当前第46页\共有63页\编于星期四\15点FractureDislocation骨折脱位当前第47页\共有63页\编于星期四\15点SubluxationofRadialHead桡骨小头半脱位当前第48页\共有63页\编于星期四\15点SubluxationofRadialHead桡骨小头半脱位1.拇指按压桡骨小头处；2.将前臂作旋后或旋活动当前第49页\共有63页\编于星期四\15点MonteggiaFracture-Dislocation

当前第50页\共有63页\编于星期四\15点MonteggiaFracture-Dislocation

当前第51页\共有63页\编于星期四\15点GaleazziFracture-Dislocati