上肢骨折和手外傷課件

1、Clavicle Fractures鎖骨骨折Anatomy Clavicle Fractures鎖骨骨折AnatomyCauses of Clavicle FractureAccidents such as falls Sometimes, a blow from a blunt object or a collision of some sortCauses of Clavicle FractureAccFracture Classification Fracture of middle 1 / 3 ( group I ) account for 80 %Fracture Classific

2、ation 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% frx of distal 1/3 (group II) Symptoms of Clavicle FracturePain Swelling Tender

3、ness Deformity Internal bleeding If asked to lift their arm, patients with a broken clavicle cannot do so without extreme pain.Symptoms of Clavicle FracturePTreatment of Clavicle Fracture The goal of treating broken bones is to set them, making them whole againfigure-8 splint or strap immobilized fo

4、r 6-8 weeksOpen reduction and internal fixationTreatment of Clavicle FractureHumerus Shaft Fractures 肱骨干骨折Humerus Shaft Fractures 肱骨干骨折Causes of Humeral Shaft Fracture Direct stress, such as a blow to the arm. Indirect forces,such as a fall,twisting or torsional forces. Causes of Humeral Shaft Fract

5、umechanismbending 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 will frx either proximal or distal ends of humerus;mechanismbending force producetypes

6、of humeral shaft fracture Transverse humeral fractures Short oblique fractures Long spiral fracturestypes of humeral shaft fracturSymptoms of humeral shaft fracturePain Loss of strength in the gripSwell DeformityTenderness If the blood supply is impaired, there may be numbness and coldness in the ar

7、m and hand.Symptoms of humeral shaft fracNon Operative Treatment of Humeral Shaft fractureLong arm splint needs to be applied from shoulder to wrist to fully immobilize the extremity;Non Operative Treatment of HumOperative Treatment:internal fixation should be reserved for fractures with inadequate

8、reduction or patients with multiple trauma;Operative Treatment:internal fIM Nailing of Humeral Shaft FracturesIM Nailing of Humeral Shaft FrPlate FixationPlate FixationAnatomySupracondylar Fracture of the Humerus肱骨髁上骨折AnatomySupracondylar Fracture CausesBy a fallThe child may stretch out his or her

9、hand and the force from the impact may be enough to cause a break in the bone. But any trauma to the area, such as an injury from a car accident, may also be a cause. CausesBy a fall- type I: non-displaced frx - type II: displaced with intact posterior cortex - type III: displaced with no cortical c

10、ontact - type I: non-displaced frx Symptomspain in the elbow swelling in the elbow inability to move the arm due to pain Symptomspain in the elbow Complicationscompartment syndromeVolkmanns contracturemedian or ulnar nerve injurystiffnessangulationmyositis ossificansComplicationscompartment syndrTre

11、atmentCase 1 TreatmentCase 1 Case 2Case 2Both bone forearm fractures前臂雙骨折Both bone forearm fractures前臂ClassificationBoth Bone Forearm FracturesLocationProximal, middle, distal third, epiphysealSkin IntegrityOpen, ClosedFracture PatternSame level, different level, associated joint disruptionMonteggia

12、 Fractures Galeazzi Fractures DisplacementRotation, translation, shortening, interosseous spaceSkeletal MaturityMature vs immatureClassificationBoth Bone ForearCase 1 : 42 year old man injured in a car accident. His left arm Case 1 : 42 year old man injuCase 2Case 2Colles fractureSmith fractureDista

13、l radius Fracture橈骨遠(yuǎn)端骨折Colles fractureSmith fractureDClassification of distal radius fracturesI Dorsal displacedColles fracturesII Palmar displacedSmith fracturesIIIComminuted fracturesClassification of distal radiu(1.) Distraction with external fixation supplemented with percutaneous Kirschner wire

14、s. (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 distal radius fractures (1.) Distraction with externalComplicationReflex sympathetic dystr

15、ophy;finger stiffness; ulnar styloid nonunion; Carpal tunnel syndrome; posttraumatic arthritis; tendon rupture carpal instabilityComplicationReflex sympatheticCase 1This 60 year oldwoman .She was treated with closed reduction and pinning. TreatmentCase 1TreatmentCase 2Preop PostopCase 2Preop PostopT

16、he Injured Hand手外傷 The Injured HandArteries of hand Arteries of hand Nerves of handNerves of handExamination of the Injured HandAt rest, fingertips normally fall into a cascade posture of increasing flexion from the index to the small finger. Examination of the Injured HanFlaps for fingertip reconst

17、ruction (1.) Palmar V-Y neurovascular island advancement flap. (2.) Dorsal cross finger flap. (3.) Thenar flap. Flaps for fingertip reconstrucTendon Injury 肌腱損傷 Tendon Injury flexor tendonsflexor tendonsflexor tendon zones1: digital sheath containing one tendon; 2: digital sheath containing two tend

18、ons (no mans land )3: palm; 4: carpal tunnel; 5: the forearm. no mans landflexor tendon zones1: digital Tendon SutureTendon SutureScaphoid fractures 舟骨骨折Scaphoid fractures 舟骨骨折Xray before two months postop two months postop Xray before Xray before two months postop Intraarticular Metacarpal base fractures關(guān)節(jié)內(nèi)掌骨基底骨折 Bennetts and reversed Bennetts fractures. Intraarticular Metacarpal baseMetacarpal Neck Fractures掌骨頸部骨折 B