上肢骨折和手外傷

ClavicleFractures

鎖骨骨折Anatomy第一頁，共五十頁。CausesofClavicleFractureAccidentssuchasfalls

Sometimes,ablowfromabluntobjectoracollisionofsomesort第二頁，共五十頁。FractureClassificationFractureofmiddle1/3(groupI)

accountfor80%第三頁，共五十頁。frxofdistal1/3(groupII)

accountfor10-15%

typeI:minimaldisplacement

typeII:frxmedialtocoracoclavicularligaments

typeIII:articularsurfacefractures

frxofmedial1/3(groupIII)accountfor5%第四頁，共五十頁。SymptomsofClavicleFracturePainSwellingTendernessDeformityInternalbleedingIfaskedtolifttheirarm,patientswithabrokenclaviclecannotdosowithoutextremepain.第五頁，共五十頁。TreatmentofClavicleFracture

Thegoaloftreatingbrokenbonesistosetthem,makingthemwholeagainfigure-8splintorstrapimmobilizedfor6-8weeksOpenreductionandinternalfixation第六頁，共五十頁。HumerusShaftFractures

肱骨干骨折第七頁，共五十頁。CausesofHumeralShaftFractureDirectstress,suchasablowtothearm.Indirectforces,suchasafall,twistingortorsionalforces.

第八頁，共五十頁。mechanismbendingforceproducestransversefrxoftheshaft;torsionforcewillresultinaspiralfracture;combinationofbendingandtorsionproduceobliquefrxw/orw/oabutterflyfragment;compressionforceswillfrxeitherproximalordistalendsofhumerus;

第九頁，共五十頁。typesofhumeralshaftfractureTransversehumeralfracturesShortobliquefracturesLongspiralfractures第十頁，共五十頁。SymptomsofhumeralshaftfracturePainLossofstrengthinthegripSwellDeformityTenderness

Ifthebloodsupplyisimpaired,theremaybenumbnessandcoldnessinthearmandhand.第十一頁，共五十頁。NonOperativeTreatmentofHumeralShaftfractureLongarmsplintneedstobeappliedfromshouldertowristtofullyimmobilizetheextremity;第十二頁，共五十頁。OperativeTreatment:internalfixationshouldbereservedforfractureswithinadequatereductionorpatientswithmultipletrauma;第十三頁，共五十頁。IMNailingofHumeralShaftFractures第十四頁，共五十頁。PlateFixation第十五頁，共五十頁。AnatomySupracondylarFracture

oftheHumerus

肱骨髁上骨折第十六頁，共五十頁。CausesByafall

Thechildmaystretchouthisorherhandandtheforcefromtheimpactmaybeenoughtocauseabreakinthebone.

Butanytraumatothearea,suchasaninjuryfromacaraccident,mayalsobeacause.

第十七頁，共五十頁。-typeI:non-displacedfrx-typeII:displacedwithintactposteriorcortex-typeIII:displacedwithnocorticalcontact第十八頁，共五十頁。Symptomspainintheelbowswellingintheelbowinabilitytomovethearmduetopain第十九頁，共五十頁。ComplicationscompartmentsyndromeVolkmann‘scontracturemedianorulnarnerveinjurystiffnessangulationmyositisossificans第二十頁，共五十頁。TreatmentCase1第二十一頁，共五十頁。Case2第二十二頁，共五十頁。Bothboneforearmfractures

前臂雙骨折第二十三頁，共五十頁。ClassificationBothBoneForearmFracturesLocationProximal,middle,distalthird,epiphysealSkinIntegrityOpen,ClosedFracturePatternSamelevel,differentlevel,associatedjointdisruption

MonteggiaFractures

GaleazziFracturesDisplacementRotation,translation,shortening,interosseousspaceSkeletalMaturityMaturevsimmature第二十四頁，共五十頁。Case1:42yearoldmaninjuredinacaraccident.Hisleftarm第二十五頁，共五十頁。Case2第二十六頁，共五十頁。CollesfractureSmithfractureDistalradiusFracture

橈骨遠(yuǎn)端骨折第二十七頁，共五十頁。ClassificationofdistalradiusfracturesIDorsaldisplacedCollesfracturesIIPalmardisplacedSmithfracturesIIIComminutedfractures第二十八頁，共五十頁。(1.)DistractionwithexternalfixationsupplementedwithpercutaneousKirschnerwires.(2.)Distractionusingatemporaryplateandscrews,tunnelledbetweentwosmallaccessincisions.(3.)Openreductionwithabuttressplate.(4.)OpenreductionwiththeMedofffixationsystem.Fixationofdistalradiusfractures第二十九頁，共五十頁。ComplicationReflexsympatheticdystrophy;fingerstiffness;ulnarstyloidnonunion;Carpaltunnelsyndrome;posttraumaticarthritis;tendonrupturecarpalinstability第三十頁，共五十頁。Case1This60yearoldwoman.Shewastreatedwithclosedreductionandpinning.Treatment第三十一頁，共五十頁。Case2PreopPostop第三十二頁，共五十頁。TheInjuredHand手外傷第三十三頁，共五十頁。Arteriesofhand第三十四頁，共五十頁。Nervesofhand第三十五頁，共五十頁。ExaminationoftheInjuredHandAtrest,fingertipsnormallyfallintoacascadepostureofincreasingflexionfromtheindextothesmallfinger.第三十六頁，共五十頁。Flapsforfingertipreconstruction(1.)PalmarV-Yneurovascularislandadvancementflap.(2.)Dorsalcrossfingerflap.(3.)Thenarflap.

第三十七頁，共五十頁。TendonInjury肌腱損傷第三十八頁，共五十頁。flexortendons第三十九頁，共五十頁。flexortendonzones1:digitalsheathcontainingonetendon;2:digitalsheathcontainingtwotendons("noman'sland")3:palm;4:carpaltunnel;5:theforearm."noman'sland"第四十頁，共五十頁。TendonSuture第四十一頁，共五十頁。Scaphoidfractures

舟骨骨折第四十二頁，共五十頁。XraybeforetwomonthspostoptwomonthspostopXraybefore第四十三頁，共五十頁。IntraarticularMetacarpalbasefractures

關(guān)節(jié)內(nèi)掌骨基底骨折Bennett'sandreversedBennett'sfractures.第四十四頁，共五十頁。MetacarpalNeckFractures

掌骨頸部骨折Boxer'sfracture

第四十五頁，共五十頁。Phalangealfractures

指骨骨折第四十六頁，共五十頁。middlephalanxbasefractureDorsalfracturedislocation

palmarfracturedislocation

第四十七頁，共五十頁。Unicondylarphalanxheadfractures

指骨頭部骨折第四十八頁，共五十頁。第四十九頁，共五十頁。內(nèi)容梗概ClavicleFractures

鎖骨骨折。HumerusShaftFractures

肱骨干骨折。Byafall。Bothboneforearmfractures

前臂雙骨折。DistalradiusFracture

橈骨遠(yuǎn)端骨折。clos