课件：骨折概论英文版本陈芒芒.ppt

ORTHOPEDICS INTRODUCTION,Wenzhou Central Hospital Traumatology Department Chen Mang-mang,Section one definition cause classification displacement,一、Definition：,The integrity and/or continuity of the bone be interruptted,二、cause,1direct violence： meas:violence direct to the bone-than fracture.,2indirect violence： translate to the bone-than fracture. Violence indirect to the fracture part.(such as colles fracture) 。 myotility ：muscles attached the bone(patella fracture) 。transverse process fracture.,3fatigue fracture ： Long-term, repeated and minor external force. the stress accumulated. such as: the second and third metatarsal fractures because of long-distance march ;distal 1/3 part fibula fracture above three types,all occur in healthy bone,called Traumatic fractures 4pathological fracture ： occur in Bone disease , Slight force 。(tumor、infection),三、classification(plenty of),（一）according to skin、Mucosa of the frature . 1、close fracture：ends of the fracture and air are interlinked. 2、open fracture：arent interlinked,（二） according to severity and shape,1、incomplete fracture ： The integrity and/or continuity of the bone be interruptted 1）linear fracture ：gap,not displaced.（The skull bone,scapula bone） 2）greendstick fracture ：Bone and periosteum partly broken ，with or without angulation deformity 。（like Willow branches ）,2、complete fracture：The integrity and/or continuity of the bone be interruptted completely According to fracture line and shape： 1）Transverse Fracture： fracture and vertical axis =vertical。 (right pic.）,三、 according to severity and shape,2）oblique fracture ： fracture line and vertical axis to form a certain Angle （as right figure）,（ according to severity and shape ）,3）spiral fracture: (right pic.）,4comminuted fracture： more than 2 fragments。（as right pic.）,三、 according to severity and shape,5）impacted fracture： the fragments compacted into the other one，mainly occurs in fracture of metaphysis 。Insert cancellous bone cortical bone inserted into cancellous bone(right pic.),三,6compression fracture ：compressed and deformed。 Occurs in spongy bone 。如spinal fracture ，calcaneal fracture。(right pic.),三,7）depressed fracture： Skull bone。 8）Epiphyseal separation： fracture line goes through the epiphyseal。,according to stable or not,1、stable fracture：the ends of the fracture is not easy to move/stabe after reduction.such as:Crack fracture, greenstick fracture, transverse fracture, compression fractures, impacted fractures etc. 2、un stable fracture：move again easily.。Such as:Oblique fracture, spiral fracture, comminuted fracture etc.,according to time,1、fresh fracture：less than 3 weeks. 2、old fracture：More than 3 weeks 。 *Involving the articular surface:Intra-articular fractures-Anatomical reduction,四、fragment displacement,Relatement: force is big/small;,the direction /character of the force 。 The weight of the distal body。 Pull force of the muscles。 Transfer/treatment is not proper.,四、 fragment displace,The most common types angular displacement lateral displacement shorten displacement separation displacement rotating displacement,Section 2:clinical manifestation and x ray examimation,General menifestation,shock Could be：serious open fracture,pelvis fracture cause：Extensive soft tissue contusion 、Severe pain 、bleeding、Visceral injury fever Hematoma,body temperature less than 38,local menifestation,usual manifestations： pain、swelling 、obstacle 。 Special signs ： deformity; abnormal movement; bony crepitus One of above 3=fracture A question?,Xray examination,Have an important value of diagnosis and treatment ,so Routinely to take the x-ray. AP-Xray,LP-Xray(contain adjacent joints ) Compared with the contralateral limb if necessary,section3 complication,（一）early complication,shock fat embolism syndrome Visceral injury(Lung, liver, spleen, bladder, urethra, rectum ) Important surrounding tissue damage （blood vessel、surrounding nerve、spinal nerve cord injury） bonefascial compartment syndrome （Common in the calves and forearm ）,（二）later complication,Hypostatic pneumonia bedsore Deep vein thrombosis of lower limbs infection（pyogenic osteomyelitis ）,2019/8/5,27,可编辑,（二） later complication,Traumatic ossification traumatic arthritis arthroclisis ischemic contraction ischemic necrosis ischemic muscle contracture,stardard of Clinical healing,Local tenderness and longitudinal taps pain; Abnormal activity X-ray show:fracture line is obscure; callus continuous observation for two weeks without deformation; Without fixion,hold the upper limbs at least for 1min,1kg;walk for 3min,at least 30 steps for lower limbs.,Section 5 Factors affectting the healing of fracture,一、Systemic factors,age Health status,二、local factors,types and quantities Blood supply Objective soft tissue injury Soft tissue insert infection,三、The influence of treatment,repeatedly gimmick reset (outer membrane injury of soft tissue and bone) Cut open reduction (soft tissue, stripping bone outer membrane) improper debridement of open fracture(bone defect caused by removing the broken bone) continuous traction inappropriately weak fixion(callus growth) Functional exercise (premature and inappropriate),Section 6 first aid of fracture,objective,Simple and effective save life、 Protect limb、e and effective Shift safely,Rescue shock: - heat preservation, the respiratory tract unobstructed The wound: - a relatively clean cloth, tourniquet (if necessary), outside the hard-core end should not be reset. fixed properly: - fracture first aid treatment is the most important one, its role is to avoid further injury, relieve pain, easy to transport, local materials. rapiddly transferred,Section 7 The principle for the treatment of fractures,Three principles for the treatment of fractures reduction fixion Functional exercise,Function restoration standard,二、fixion,External fixion splint plaster -bracket、brace Traction system External fixion,Internal fixtion plate screw intramedullary nail,三、functional exercise,Section 8 how to deal with open fracture,most dangerous complicationinfection3 types:,debridement time limited 6-8h，contaminated,First phase of the suture 8-24h，debridement may could over24h，Dont debridement,Debridement tips clean up: , a tourniquet best not to use. cleaning resection margin, a