骨折概论(英文版本)---陈芒芒ppt课件

.,ORTHOPEDICSINTRODUCTION,WenzhouCentralHospitalTraumatologyDepartmentChenMang-mang,.,Sectiononedefinitioncauseclassificationdisplacement,.,一、Definition：,Theintegrityand/orcontinuityofthebonebeinterruptted,.,二、cause,1directviolence：meas:violencedirecttothebone-thanfracture.,.,2indirectviolence：translatetothebone-thanfracture.Violenceindirecttothefracturepart.(suchascollesfracture)。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：arentinterlinked,.,（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。,.,accordingtostableornot,1、stablefracture：theendsofthefractureisnoteasytomove/stabeafterreduction.suchas:Crackfracture,greenstickfracture,transversefracture,compressionfractures,impactedfracturesetc.2、unstablefracture：moveagaineasily.。Suchas:Obliquefracture,spiralfracture,comminutedfractureetc.,.,accordingtotime,1、freshfracture：lessthan3weeks.2、oldfracture：Morethan3weeks。*Involvingthearticularsurface:Intra-articularfractures-Anatomicalreduction,.,四、fragmentdisplacement,Relatement:forceisbig/small;,thedirection/characteroftheforce。Theweightofthedistalbody。Pullforceofthemuscles。Transfer/treatmentisnotproper.,.,四、fragmentdisplace,Themostcommontypesangulardisplacementlateraldisplacementshortendisplacementseparationdisplacementrotatingdisplacement,.,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,.,mostdangerouscomplicationinfection3types:,.,debridementtimelimited6-8h，contaminated,Firstphaseofthesuture8-24h，debridementmaycouldover24h，Dontdebridement,.,Debridementtipscleanup:,atourniquetbestnott