上肢骨折和手外伤.ppt

ClavicleFractures锁骨骨折,Anatomy,CausesofClavicleFracture,AccidentssuchasfallsSometimes,ablowfromabluntobjectoracollisionofsomesort,FractureClassification,Fractureofmiddle1/3(groupI)accountfor80%,frxofdistal1/3(groupII)accountfor10-15%typeI:minimaldisplacementtypeII:frxmedialtocoracoclavicularligamentstypeIII:articularsurfacefracturesfrxofmedial1/3(groupIII)accountfor5%,SymptomsofClavicleFracture,PainSwellingTendernessDeformityInternalbleedingIfaskedtolifttheirarm,patientswithabrokenclaviclecannotdosowithoutextremepain.,TreatmentofClavicleFracture,Thegoaloftreatingbrokenbonesistosetthem,makingthemwholeagainfigure-8splintorstrapimmobilizedfor6-8weeksOpenreductionandinternalfixation,HumerusShaftFractures肱骨干骨折,CausesofHumeralShaftFracture,Directstress,suchasablowtothearm.Indirectforces,suchasafall,twistingortorsionalforces.,mechanism,bendingforceproducestransversefrxoftheshaft;torsionforcewillresultinaspiralfracture;combinationofbendingandtorsionproduceobliquefrxw/orw/oabutterflyfragment;compressionforceswillfrxeitherproximalordistalendsofhumerus;,typesofhumeralshaftfracture,TransversehumeralfracturesShortobliquefracturesLongspiralfractures,Symptomsofhumeralshaftfracture,PainLossofstrengthinthegripSwellDeformityTendernessIfthebloodsupplyisimpaired,theremaybenumbnessandcoldnessinthearmandhand.,NonOperativeTreatmentofHumeralShaftfracture,Longarmsplintneedstobeappliedfromshouldertowristtofullyimmobilizetheextremity;,OperativeTreatment:,internalfixationshouldbereservedforfractureswithinadequatereductionorpatientswithmultipletrauma;,IMNailingofHumeralShaftFractures,PlateFixation,Anatomy,SupracondylarFractureoftheHumerus肱骨髁上骨折,Causes,ByafallThechildmaystretchouthisorherhandandtheforcefromtheimpactmaybeenoughtocauseabreakinthebone.Butanytraumatothearea,suchasaninjuryfromacaraccident,mayalsobeacause.,-typeI:non-displacedfrx-typeII:displacedwithintactposteriorcortex-typeIII:displacedwithnocorticalcontact,Symptoms,painintheelbowswellingintheelbowinabilitytomovethearmduetopain,Complications,compartmentsyndromeVolkmannscontracturemedianorulnarnerveinjurystiffnessangulationmyositisossificans,Treatment,Case1,Case2,Bothboneforearmfractures前臂双骨折,Classification,Case1:42yearoldmaninjuredinacaraccident.Hisleftarm,Case2,Collesfracture,Smithfracture,DistalradiusFracture桡骨远端骨折,(1.)DistractionwithexternalfixationsupplementedwithpercutaneousKirschnerwires.(2.)Distractionusingatemporaryplateandscrews,tunnelledbetweentwosmallaccessincisions.(3.)Openreductionwithabuttressplate.(4.)OpenreductionwiththeMedofffixationsystem.,Fixationofdistalradiusfractures,Complication,Reflexsympatheticdystrophy;fingerstiffness;ulnarstyloidnonunion;Carpaltunnelsyndrome;posttraumaticarthritis;tendonrupturecarpalinstability,Case1This60yearoldwoman.Shewastreatedwithclosedreductionandpinning.,Treatment,Case2,Preop,Postop,TheInjuredHand手外伤,Arteriesofhand,Nervesofhand,ExaminationoftheInjuredHand,Atrest,fingertipsnormallyfallintoacascadepostureofincreasingflexionfromtheindextothesmallfinger.,Flapsforfingertipreconstruction,(1.)PalmarV-Yneurovascularislandadvancementflap.(2.)Dorsalcrossfingerflap.(3.)Thenarflap.,TendonInjury肌腱损伤,flexortendons,flexortendonzones,1:digitalsheathcontainingonetendon;2:digitalsheathcontainingtwotendons(nomansland)3:palm;4:carpaltunnel;5:theforearm.,nomansland,TendonSuture,Scaphoidfractures舟骨骨折,Xraybefore,twomonthspostop,twomonthspostop,Xraybefore,IntraarticularMetacarpalbasefractures关节内掌骨基底骨折,BennettsandreversedBennettsfractures.,Met