上肢骨折与手外伤.ppt

Causes of Clavicle Fracture,Accidents such as falls Sometimes, a blow from a blunt object or a collision of some sort,Fracture Classification,Fracture of middle 1 / 3 ( group I ) account for 80 %,frx 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%,Symptoms of Clavicle Fracture,Pain Swelling Tenderness Deformity Internal bleeding If asked to lift their arm, patients with a broken clavicle cannot do so without extreme pain.,Treatment of Clavicle Fracture,The goal of treating broken bones is to set them, making them whole again figure-8 splint or strap immobilized for 6-8 weeks Open reduction and internal fixation,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.,mechanism,bending 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;,types of humeral shaft fracture,Transverse humeral fractures Short oblique fractures Long spiral fractures,Symptoms of humeral shaft fracture,Pain Loss of strength in the grip Swell Deformity Tenderness If the blood supply is impaired, there may be numbness and coldness in the arm and hand.,Non Operative Treatment of Humeral Shaft fracture,Long arm splint needs to be applied from shoulder to wrist to fully immobilize the extremity;,Operative Treatment:,internal fixation should be reserved for fractures with inadequate reduction or patients with multiple trauma;,IM Nailing of Humeral Shaft Fractures,Plate Fixation,Anatomy,Supracondylar Fracture of the Humerus 肱骨髁上骨折,Causes,By a fall The child may stretch out his or her 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.,- type I: non-displaced frx - type II: displaced with intact posterior cortex - type III: displaced with no cortical contact,Symptoms,pain in the elbow swelling in the elbow inability to move the arm due to pain,Complications,compartment syndrome Volkmanns contracture median or ulnar nerve injury stiffness angulation myositis ossificans,Treatment,Case 1,Case 2,Both bone forearm fractures 前臂双骨折,Classification,Case 1 : 42 year old man injured in a car accident. His left arm,Case 2,Colles fracture,Smith fracture,Distal radius Fracture 桡骨远端骨折,(1.) Distraction with external fixation supplemented with percutaneous Kirschner wires. (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,Complication,Reflex sympathetic dystrophy; finger stiffness; ulnar styloid nonunion; Carpal tunnel syndrome; posttraumatic arthritis; tendon rupture carpal instability,Case 1 This 60 year old woman . She was treated with closed reduction and pinning.,Treatment,Case 2,Preop,Postop,The Injured Hand 手外伤,Arteries of hand,Nerves of hand,Examination of the Injured Hand,At rest, fingertips normally fall into a cascade posture of increasing flexion from the index to the small finger.,Flaps for fingertip reconstruction,(1.) Palmar V-Y neurovascular island advancement flap. (2.) Dorsal cross finger flap. (3.) Thenar flap.,Tendon Injury 肌腱损伤,flexor tendons,flexor tendon zones,1: digital sheath containing one tendon; 2: digital sheath containing two tendons (“no mans land“ ) 3: palm; 4: carpal tunnel; 5: the forearm.,“no mans land“,Tendon Suture,Scaphoid fractures 舟骨骨折,Xray before,two months postop,two months postop,Xray before,Intraarticular Metacarpal base fractures 关节内掌骨基底骨折,Bennetts and reversed Bennetts frac