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.(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:,atourniquetbestno