骨折概论(英文版本)---陈芒芒.ppt

ORTHOPEDICSINTRODUCTION WenzhouCentralHospitalTraumatologyDepartmentChenMang mang Sectiononedefinitioncauseclassificationdisplacement 一 Definition Theintegrityand orcontinuityofthebonebeinterruptted 二 cause 1directviolence meas violencedirecttothebone thanfracture 2indirectviolence translatetothebone thanfracture Violenceindirecttothefracturepart suchascolle sfracture myotility musclesattachedthebone patellafracture transverseprocessfracture 3fatiguefracture Long term repeatedandminorexternalforce thestressaccumulated suchas thesecondandthirdmetatarsalfracturesbecauseoflong distancemarch distal1 3partfibulafractureabovethreetypes alloccurinhealthybone calledTraumaticfractures4pathologicalfracture occurinBonedisease Slightforce tumor infection 三 classification plentyof 一 accordingtoskin Mucosaofthefrature 1 closefracture endsofthefractureandairareinterlinked 2 openfracture aren tinterlinked 二 accordingtoseverityandshape 1 incompletefracture Theintegrityand orcontinuityofthebonebeinterruptted1 linearfracture gap notdisplaced Theskullbone scapulabone 2 greendstickfracture Boneandperiosteumpartlybroken withorwithoutangulationdeformity likeWillowbranches 2 completefracture Theintegrityand orcontinuityofthebonebeinterrupttedcompletelyAccordingtofracturelineandshape 1 TransverseFracture fractureandverticalaxis vertical rightpic 三 accordingtoseverityandshape 2 obliquefracture fracturelineandverticalaxistoformacertainAngle asrightfigure accordingtoseverityandshape 3 spiralfracture rightpic 4comminutedfracture morethan2fragments asrightpic 三 accordingtoseverityandshape 5 impactedfracture thefragmentscompactedintotheotherone mainlyoccursinfractureofmetaphysis Insertcancellousbonecorticalboneinsertedintocancellousbone rightpic 三 6compressionfracture compressedanddeformed Occursinspongybone 如spinalfracture calcanealfracture rightpic 三 7 depressedfracture Skullbone 8 Epiphysealseparation fracturelinegoesthroughtheepiphyseal accordingto stableornot 1 stablefracture theendsofthefractureisnoteasytomove stabeafterreduction suchas Crackfracture greenstickfracture transversefracture compressionfractures impactedfracturesetc 2 unstablefracture moveagaineasily Suchas Obliquefracture spiralfracture comminutedfractureetc accordingto time 1 freshfracture lessthan3weeks 2 oldfracture Morethan3weeks Involvingthearticularsurface Intra articularfractures Anatomicalreduction 四 fragmentdisplacement Relatement forceisbig small thedirection characteroftheforce Theweightofthedistalbody Pullforceofthemuscles Transfer treatmentisnotproper 四 fragmentdisplace Themostcommontypes angulardisplacement lateraldisplacement shortendisplacement separationdisplacement rotatingdisplacement Section2 clinicalmanifestationandxrayexamimation Generalmenifestation shockCouldbe seriousopenfracture pelvisfracturecause Extensivesofttissuecontusion Severepain bleeding VisceralinjuryfeverHematoma bodytemperaturelessthan38 localmenifestation usualmanifestations pain swelling obstacle Specialsigns deformity abnormalmovement bonycrepitusOneofabove3 fractureAquestion Xrayexamination Haveanimportantvalueofdiagnosisandtreatment soRoutinelytotakethex ray AP Xray LP Xray containadjacentjoints Comparedwiththecontralaterallimbifnecessary section3complication 一 earlycomplication shockfatembolismsyndromeVisceralinjury Lung liver spleen bladder urethra rectum Importantsurroundingtissuedamage bloodvessel surroundingnerve spinalnervecordinjury bonefascialcompartmentsyndrome Commoninthecalvesandforearm 二 latercomplication HypostaticpneumoniabedsoreDeepveinthrombosisoflowerlimbsinfection pyogenicosteomyelitis 二 latercomplication Traumaticossificationtraumaticarthritisarthroclisisischemiccontractionischemicnecrosisischemicmusclecontracture stardardofClinicalhealing Localtendernessandlongitudinaltapspain AbnormalactivityX rayshow fracturelineisobscure calluscontinuousobservationfortwoweekswithoutdeformation Withoutfixion holdtheupperlimbsatleastfor1min 1kg walkfor3min atleast30stepsforlowerlimbs Section5Factorsaffecttingthehealingoffracture 一 Systemicfactors ageHealthstatus 二 localfactors typesandquantitiesBloodsupplyObjectivesofttissueinjurySofttissueinsertinfection 三 Theinfluenceoftreatment repeatedlygimmickreset outermembraneinjuryofsofttissueandbone Cutopenreduction softtissue strippingboneoutermembrane improperdebridementofopenfracture bonedefectcausedbyremovingthebrokenbone continuoustractioninappropriatelyweakfixion callusgrowth Functionalexercise prematureandinappropriate Section6firstaidoffracture objective Simpleandeffectivesavelife Protectlimb eandeffectiveShiftsafely Rescueshock heatpreservation therespiratorytractunobstructedThewound arelativelycleancloth tourniquet ifnecessary outsidethehard coreendshouldnotbereset fixedproperly fracturefirstaidtreatmentisthemostimportantone itsroleistoavoidfurtherinjury relievepain easytotransport localmaterials rapiddlytransferred Section7Theprincipleforthetreatmentoffractures ThreeprinciplesforthetreatmentoffracturesreductionfixionFunctionalexercise Functionrestorationstandard 二 fixion Externalfixionsplintplaster bracket braceTractionsystemExternalfixion Internalfixtionplatescrewintramedullarynail 三 functionalexercise Section8howtodealwithopenfracture mostdangerouscomplication infection3types debridementtimelimited6 8h contaminated Firstphaseofthesuture8 24h debridementmaycouldover24h Don tdebridement Debridementtipscleanup atourniquetbestnott