骨折处理的基本原则(参考)课件

1、PRINCIPLES OF TREATMENT OF FRACTURESGOALS OF FRACTURE TREATMENTRestore the patient to optimal functional statePrevent fracture and soft-tissue complicationsGet the fracture to heal, and in a position which will produce optimal functional recoveryRehabilitate the patient as early as possibleHOW FRACT

2、URES HEALIn natureRegeneration vs repairThree phases of healing by callusRapid process, rehabilitation slow, low riskWith operative intervention (reduction + compression)Primary bone healingSlow process, rehabilitation rapid, high riskWith operative intervention (nailing or external fixation)Healing

3、 by callusRapid process, rehabilitation rapid, lesser riskHIGH-ENERGY INJURYLOW ENERGY INJURYDESCRIBING THE FRACTUREMechanism of injury (traumatic, pathological, stress)Anatomical site (bone and location in bone)Configuration Displacement three planes of angulationtranslationshorteningArticular invo

4、lvement/epiphyseal injuries fracture involving jointdislocationligamentous avulsionSoft tissue injuryMINIMALLY DISPLACED DISTAL RADIUS FRACTUREMANAGEMENT OF THE INJURED PATIENTLife saving measuresDiagnose and treat life threatening injuriesEmergency orthopaedic involvement Life savingComplication sa

5、vingEmergency orthopaedic management (Day 1)Monitoring of fracture (Days to weeks)Rehabilitation + treatment of complications (weeks to months)LIFE SAVING MEASURESAAirway and cervical spine immobilisationBBreathingCCirculation (treatment and diagnosis of cause)DDisability (head injury)EExposure (mus

6、culo-skeletal injury)EMERGENCY ORTHOPAEDIC MANAGEMENTLife saving measures Reducing a pelvic fracture in haemodynamically unstable patientApplying pressure to reduce haemorrhage from open fractureComplication savingEarly and complete diagnosis of the extent of injuriesDiagnosing and treating soft-tis

7、sue injuriesDIAGNOSING THE SOFT TISSUE INJURYSkinOpen fractures, degloving injuries and ischaemic necrosisMusclesCrush and compartment syndromesBlood vesselsVasospasm and arterial lacerationNervesNeurapraxias, axonotmesis, neurotmesisLigamentsJoint instability and dislocationSEVERE SOFT-TISSUE INJUR

8、YTREATING THE SOFT TISSUE INJURYAll severe soft tissue injuriesequire urgent treatmentOpen fractures , Vascular injuries, Nerve injuries, Compartment syndromes, Fracture/dislocationsAfter the treatment of the soft tissue injury the fracture requires rigid fixationA severe soft-tissue injury will del

9、ay fracture healingDIAGNOSING THE BONE INJURYClinical assessmentHistoryCo-morbiditiesExposure/systematic examination“First-aid” reductionSplintage and analgesiaRadiographsTwo planes including joints above and below area of injuryTREATING THE FRACTURE IDoes the fracture require reduction?Is it displa

10、ced?Does it need to be reduced? (e.g. clavicle, ribs, MTs)How accurate a reduction do we need?alignment without angulation (closed reduction - e.g. wrist)anatomic (open reduction - e.g. adult forearm )TREATING THE FRACTURE IIHow are we going to hold the reduction?Semi-rigid (Plaster)Rigid (Internal

11、fixation)What treatment plan will we follow?When can the patient load the injured limb?When can the patient be allowed to move the joints?How long will we have to immobilise the fracture for?TREATING THE FRACTURE IIIOperative Non-optveRehabilitationRapidSlowRisk of joint stiffnessLowPresentRisk of m

12、alunionLowPresentRisk of non-unionPresentPresentSpeed of healingSlowRapidRisk of infectionPresentLowCost? ?INDICATIONS FOR OPERATIVE TREATMENTGeneral trend toward operative treatment last 30 yrsImproved implants and antibiotic prophylaxis, Use of closed and minimally invasive methodsCurrent absolute

13、 indications:-PolytraumaDisplaced intra-articular fracturesOpen #s#s with vascular inj or compartment syn, Pathological #sNon-unionsCurrent relative indications:-Loss of position with closed method, Poor functional result with non-anatomical reduction, Displaced fractures with poor blood supply, Eco

14、nomic and medical indicationsWHEN IS THE FRACTURE HEALED?ClinicallyUpper limbLower limbAdult6-8 weeks12-16 weeksChild3-4 weeks6-8 weeksRadiologicallyBridging callus formationRemodellingBiomechanicallyREHABILITATIONRestoring the patient as close to pre-injury functional level as possibleMay not be possible with:-Severe fractures or other injuriesFrail, elderly patientsApproach needs to be:-Pragmatic with realistic targetsMultidisciplinaryPhysiotherapist, Occupational therapist, District nurse, GP, Social workerC