上肢骨折与关节损伤吕海ppt2概要课件

Email:1909506987 Tel上肢骨折与关节损伤 Fractures & Dislocations of the Upper Limb,南方医科大学第二临床医学院外科学教研室 吕 海,Upper Limb Include,Clavicle 锁骨 Scapula 肩胛骨 Shoulder Joint 肩关节 Humerus 肱骨 Elbow Joint 肘关节 Radius and Ulna尺桡骨 Wrist Joint 腕关节 Scaphoid Bone 舟状骨,Mechanism 损伤机制,Mostly Indirect Commonly described as “ a fall on outstretched hand “ Type of injury depends on position of the upper limb at the time of impact : Flexed屈曲, Extended伸直, Adducted内收, Abducted外展, Pronated旋前 or Supinated旋后,Fracture of the Clavicle 锁骨骨折,Common especially in children and elderly Commonest site is the middle one third Mainly due to indirect injury Direct injury leads to comminuted fracture,,Treatment,Conservative by an arm sling手臂吊带 or eight bandage 八字绷带 Operative fixation is indicated if there is an open fracture, neurovascular injury or nonunion,,Figure of eight Bandage 8字固定带,Acromio Clavicular J 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,Hook Plate 钩钢板,,Dislocation of the Shoulder 肩关节脱位,Mostly Anterior 95 % of dislocations Posterior Dislocation occurs 5 % True Inferior dislocation (luxatio erecta 直举性肱骨脱位) occurs 1% Habitual 习惯性脱位 Non traumatic dislocation may present as Multi directional dislocation due to generalized ligamentous laxity and is Painless,Inferior,Mechanism 机制,Usually Indirect fall on Abducted and extended shoulder May be direct when there is a blow on the shoulder from behind,Anterior Shoulder dislocation,Usually also inferior Bankarts Lesion 前盂唇损伤,,Clinical Picture,Patient is in pain Holds the injured limb with other hand close to the trunk The shoulder is abducted and the elbow is kept flexed There is loss of the normal contour 轮廓 of the shoulder,,Clinical Picture,Loss of the contour of the shoulder may appear as a step Anterior bulge膨胀 of head of humerus may be visible or palpable A gap can be palpated above the dislocated head of the humerus,X Ray of Dislocation of Shoulder,Associated Injuries of Shoulder Dislocation,Injury to the neuro vascular bundle in axilla ( rare ) Injury of the Axillary腋神经 ( Usually stretching leading to temporary neuropraxia ) Associated fracture,Axillary Nerve Injury 腋神经伤,Also called circumflex nerve It is a branch from posterior cord of Brachial plexus It hooks close round neck of humerus from posterior to anterior It pierces the deep surface of deltoid 三角肌 and supply it and the part of skin over it,Management of Shoulder Dislocation,Is an Emergency It should be reduced in less than 24 hours or there may be Avascular Necrosis of head of humerus Following reduction the shoulder should be immobilised strapped to the trunk for 3-4 weeks and rested in a collar and cuff,Methods of Reduction,Hippocrates Method ( Anesthesia麻醉 is required ) Stimpsons technique (Sedation镇静 and Analgesia止痛 are used, but No anesthesia) Kochers technique is the method used in hospitals under general anesthesia and muscle relaxation,Hippocrates Method,Stimpsons technique,Kochers Technique,Complications of Shoulder Dislocation : Early,Neuro vascular injury ( rare ) Axillary nerve injury Associated Fracture of neck of humerus or greater or lesser tuberosities（肱骨结节）,Complications of Shoulder Dislocation : Late,Avascular necrosis of the head of the Humerus (high risk with delayed reduction) Heterotopic calcification ( used to be called Myositis Ossificans )骨化性肌炎 Recurrent dislocation,Fractures of The Humerus,Proximal Humerus: surgical and anatomical neck Shaft of Humerus Distal humerus,Fractures of The Humerus,Fracture Proximal Humerus,Intra-medullary K wire fixation,Fractures Shaft of the Humerus,Commonly Indirect Indirect injury results in Spiral or Oblique fractures Direct injuries results in transverse or comminuted fracture May be associated with Radial Nerve injury,Fracture shaft of the Humerus,Treatment : Plating or Nail,Fracture Distal of the Humerus,Radial Nerve Injury,Results in Wrist drop Associated with fracture humerus in up to 12% of fractures 2/3 ( 8%) of Radial injury are Neuropraxia(神经失用),Management of Radial Nerve Injury,When present in open fractures ; immediate exploration and repair In closed injuries treated conservatively ; initial management is doing Nerve Conduction Studies ( NCS ) and Electromyography ( EMG ) and awaiting for spontaneous recovery,Management of Radial Nerve injury,Recovery usually starts after few days but may take up to 9 months for full recovery If No spontaneous recovery occurs in 12 weeks confirmed by NCS and EMG ;then exploration of the nerve should be carried out,Management of Humerus Shaft Fracture,Most of the time is Conservative Closed Reduction in upright position followed by application of U shaped Slab or Cylinder cast Few weeks later or initially in stable fractures Functional Brace may be used,U Shaped Slab of POP,Functional Brace 功能支具,Indications for ORIF 切开复位内固定,Failure to reduce fracture conservatively 保守失败 Bilateral humeral fractures 双侧骨折 Open fracture with radial nerve Injury 开放骨折并神经伤 Unconscious patient 昏迷病人 Delayed-Union 延迟愈合 Non-Union 不愈合 Mal-Union 畸形愈合,ORIF：open reduction internal fixation,Supra-condylar Fracture of Humerus 肱骨髁上骨折,Pediatric Supra-Condylar Humeral Fracture,Pediatric Supra-condylar fracture,Reduction of supra-condylar Fracture,Absolute Emergency Should be done by experienced doctor as soon as possible In the past the arm was held in flexed elbow position in back-slab POP after reduction At present time Percutaneous K wire fixation is ALWAYS carried out after reduction,Complications Supra-Condylar Fractures,Early= Compartment syndrome （Volkmanns Ischemia） Late= Stiffness Volkmanns Ischemic Heterotopic Calcification Mal-Union (Valgus or varus),Supracondylar fracture,Eblow Dislocation 肘关节脱位,Football Weightlifting,Elbow Reduction 肘关节复位,.,Fracture Dislocation 骨折脱位,Subluxation of Radial Head 桡骨小头半脱位,Subluxatio