上肢骨折與關節(jié)損傷演示文稿

上肢骨折與關節(jié)損傷演示文稿當前第1頁\共有62頁\編于星期四\15點（優(yōu)選）上肢骨折與關節(jié)損傷當前第2頁\共有62頁\編于星期四\15點Mechanism損傷機制MostlyIndirectCommonlydescribedas“afallonoutstretchedhand“Typeofinjurydependsonpositionoftheupperlimbatthetimeofimpact:Flexed屈曲,Extended伸直,Adducted內收,Abducted外展,Pronated旋前orSupinated旋后當前第3頁\共有62頁\編于星期四\15點FractureoftheClavicle鎖骨骨折CommonespeciallyinchildrenandelderlyCommonestsiteisthemiddleonethirdMainlyduetoindirectinjuryDirectinjuryleadstocomminutedfracture當前第4頁\共有62頁\編于星期四\15點當前第5頁\共有62頁\編于星期四\15點TreatmentConservativebyanarmsling手臂吊帶oreightbandage八字繃帶Operativefixationisindicatedifthereisanopenfracture,neurovascularinjuryornonunion當前第6頁\共有62頁\編于星期四\15點FigureofeightBandage8字固定帶當前第7頁\共有62頁\編于星期四\15點AcromioClavicularJ

Disloc

肩鎖關節(jié)脫位I型：關節(jié)囊、韌帶未斷裂II型：關節(jié)囊破裂III型：關節(jié)囊、韌帶完全斷裂HookPlate鉤鋼板當前第8頁\共有62頁\編于星期四\15點DislocationoftheShoulder肩關節(jié)脫位MostlyAnterior>95%ofdislocationsPosteriorDislocationoccurs<5%TrueInferiordislocation(luxatioerecta直舉性肱骨脫位)occurs<1% Habitual

習慣性脫位NontraumaticdislocationmaypresentasMultidirectionaldislocationduetogeneralizedligamentouslaxityandisPainless

Inferior當前第9頁\共有62頁\編于星期四\15點Mechanism機制UsuallyIndirectfallonAbductedandextendedshoulderMaybedirectwhenthereisablowontheshoulderfrombehind當前第10頁\共有62頁\編于星期四\15點AnteriorShoulderdislocationUsuallyalsoinferiorBankart’sLesion前盂唇損傷當前第11頁\共有62頁\編于星期四\15點ClinicalPicturePatientisinpainHoldstheinjuredlimbwithotherhandclosetothetrunkTheshoulderisabductedandtheelbowiskeptflexedThereislossofthenormalcontour輪廓oftheshoulder當前第12頁\共有62頁\編于星期四\15點ClinicalPictureLossofthecontouroftheshouldermayappearasastepAnteriorbulge膨脹ofheadofhumerusmaybevisibleorpalpableAgapcanbepalpatedabovethedislocatedheadofthehumerus當前第13頁\共有62頁\編于星期四\15點XRayofDislocationofShoulder

當前第14頁\共有62頁\編于星期四\15點AssociatedInjuriesofShoulderDislocationInjurytotheneurovascularbundleinaxilla(rare)Injuryof

theAxillary腋神經(jīng)(Usuallystretchingleadingtotemporaryneuropraxia)Associatedfracture當前第15頁\共有62頁\編于星期四\15點AxillaryNerveInjury腋神經(jīng)傷AlsocalledcircumflexnerveItisabranchfromposteriorcordofBrachialplexusIthookscloseroundneckofhumerusfromposteriortoanteriorItpiercesthedeepsurfaceofdeltoid三角肌andsupplyitandthepartofskinoverit當前第16頁\共有62頁\編于星期四\15點ManagementofShoulderDislocationIsanEmergencyItshouldbereducedinlessthan24hoursortheremaybeAvascularNecrosisofheadofhumerusFollowingreductiontheshouldershouldbeimmobilisedstrappedtothetrunkfor3-4weeksandrestedinacollarandcuff當前第17頁\共有62頁\編于星期四\15點MethodsofReductionHippocratesMethod(Anesthesia麻醉isrequired)Stimpson’stechnique(Sedation鎮(zhèn)靜andAnalgesia止痛areused,butNoanesthesia)Kocher’stechniqueisthemethodusedinhospitalsundergeneralanesthesiaandmusclerelaxation當前第18頁\共有62頁\編于星期四\15點HippocratesMethod當前第19頁\共有62頁\編于星期四\15點Stimpson’stechnique當前第20頁\共有62頁\編于星期四\15點Kocher’sTechnique當前第21頁\共有62頁\編于星期四\15點ComplicationsofShoulderDislocation:EarlyNeurovascularinjury(rare)AxillarynerveinjuryAssociatedFractureofneckofhumerusorgreaterorlessertuberosities（肱骨結節(jié)）當前第22頁\共有62頁\編于星期四\15點ComplicationsofShoulderDislocation:LateAvascularnecrosisoftheheadoftheHumerus(highriskwithdelayedreduction)Heterotopiccalcification(usedtobecalledMyositisOssificans)骨化性肌炎Recurrentdislocation當前第23頁\共有62頁\編于星期四\15點FracturesofTheHumerusProximalHumerus:surgicalandanatomicalneckShaftofHumerusDistalhumerus當前第24頁\共有62頁\編于星期四\15點FracturesofTheHumerus當前第25頁\共有62頁\編于星期四\15點FractureProximalHumerus當前第26頁\共有62頁\編于星期四\15點Intra-medullaryKwirefixation當前第27頁\共有62頁\編于星期四\15點FracturesShaftoftheHumerusCommonlyIndirectIndirectinjuryresultsinSpiralorObliquefracturesDirectinjuriesresultsintransverseorcomminutedfractureMaybeassociatedwithRadialNerveinjury當前第28頁\共有62頁\編于星期四\15點FractureshaftoftheHumerus當前第29頁\共有62頁\編于星期四\15點Treatment:PlatingorNail當前第30頁\共有62頁\編于星期四\15點FractureDistaloftheHumerus當前第31頁\共有62頁\編于星期四\15點RadialNerveInjuryResultsinWristdropAssociatedwithfracture

humerusinupto12%offractures2/3(8%)ofRadialinjuryareNeuropraxia(神經(jīng)失用)當前第32頁\共有62頁\編于星期四\15點ManagementofRadialNerveInjuryWhenpresentinopenfractures;immediateexplorationand±repairInclosedinjuriestreatedconservatively;initialmanagementisdoingNerveConductionStudies(NCS)andElectromyography(EMG)andawaitingforspontaneousrecovery當前第33頁\共有62頁\編于星期四\15點ManagementofRadialNerveinjuryRecoveryusuallystartsafterfewdaysbutmaytakeupto9monthsforfullrecoveryIfNospontaneousrecoveryoccursin12weeksconfirmedbyNCSandEMG;thenexplorationofthenerveshouldbecarriedout當前第34頁\共有62頁\編于星期四\15點ManagementofHumerusShaftFractureMostofthetimeisConservativeClosedReductioninuprightpositionfollowedbyapplicationofUshapedSlaborCylindercastFewweekslaterorinitiallyinstablefracturesFunctionalBracemaybeused當前第35頁\共有62頁\編于星期四\15點UShapedSlabofPOP當前第36頁\共有62頁\編于星期四\15點FunctionalBrace功能支具當前第37頁\共有62頁\編于星期四\15點IndicationsforORIF切開復位內固定Failuretoreducefractureconservatively保守失敗Bilateralhumeralfractures雙側骨折OpenfracturewithradialnerveInjury開放骨折并神經(jīng)傷Unconsciouspatient昏迷病人Delayed-Union延遲愈合Non-Union不愈合Mal-Union畸形愈合當前第38頁\共有62頁\編于星期四\15點ORIF：openreduction

internalfixation當前第39頁\共有62頁\編于星期四\15點Supra-condylarFractureofHumerus肱骨髁上骨折當前第40頁\共有62頁\編于星期四\15點PediatricSupra-CondylarHumeralFracture當前第41頁\共有62頁\編于星期四\15點PediatricSupra-condylarfracture當前第42頁\共有62頁\編于星期四\15點Reductionofsupra-condylarFractureAbsoluteEmergencyShouldbedonebyexperienceddoctorassoonaspossibleInthepastthearmwasheldinflexedelbowpositioninback-slabPOPafterreductionAtpresenttimePercutaneousKwirefixationisALWAYS

carriedoutafterreduction當前第43頁\共有62頁\編于星期四\15點ComplicationsSupra-CondylarFracturesEarly=Compartmentsyndrome（Volkmann‘sIschemia）

Late=Stiffness

Volkmann'sIschemicHeterotopicCalcification

Mal-Union(Valgusorvarus)當前第44頁\共有62頁\編于星期四\15點Supracondylarfracture當前第45頁\共有62頁\編于星期四\15點EblowDislocation肘關節(jié)脫位FootballWeightlifting當前第46頁\共有62頁\編于星期四\15點ElbowReduction肘關節(jié)復位.當前第47頁\共有62頁\編于星期四\15點FractureDislocation骨折脫位當前第48頁\共有62頁\編于星期四\15點SubluxationofRadialHead橈骨小頭半脫位當前第49頁\共有62頁\編于星期四\15點SubluxationofRadialHead橈骨小頭半脫位1.拇指按壓橈骨小頭處；2.將前臂作旋后或旋活動當前第50頁