上肢骨折与关节损伤吕海

UpperLimbIncludeClavicle锁骨Scapula肩胛骨ShoulderJoint肩关节Humerus肱骨ElbowJoint肘关节RadiusandUlna尺桡骨WristJoint腕关节ScaphoidBone舟状骨当前1页，总共63页。Mechanism损伤机制MostlyIndirectCommonlydescribedas“afallonoutstretchedhand“Typeofinjurydependsonpositionoftheupperlimbatthetimeofimpact:Flexed屈曲,Extended伸直,Adducted内收,Abducted外展,Pronated旋前orSupinated旋后当前2页，总共63页。FractureoftheClavicle锁骨骨折CommonespeciallyinchildrenandelderlyCommonestsiteisthemiddleonethirdMainlyduetoindirectinjuryDirectinjuryleadstocomminutedfracture当前3页，总共63页。当前4页，总共63页。TreatmentConservativebyanarmsling手臂吊带oreightbandage八字绷带Operativefixationisindicatedifthereisanopenfracture,neurovascularinjuryornonunion当前5页，总共63页。FigureofeightBandage8字固定带当前6页，总共63页。AcromioClavicularJ

Disloc

肩锁关节脱位I型：关节囊、韧带未断裂II型：关节囊破裂III型：关节囊、韧带完全断裂HookPlate钩钢板当前7页，总共63页。DislocationoftheShoulder肩关节脱位MostlyAnterior>95%ofdislocationsPosteriorDislocationoccurs<5%TrueInferiordislocation(luxatioerecta直举性肱骨脱位)occurs<1% Habitual

习惯性脱位NontraumaticdislocationmaypresentasMultidirectionaldislocationduetogeneralizedligamentouslaxityandisPainless

Inferior当前8页，总共63页。Mechanism机制UsuallyIndirectfallonAbductedandextendedshoulderMaybedirectwhenthereisablowontheshoulderfrombehind当前9页，总共63页。AnteriorShoulderdislocationUsuallyalsoinferiorBankart’sLesion前盂唇损伤当前10页，总共63页。ClinicalPicturePatientisinpainHoldstheinjuredlimbwithotherhandclosetothetrunkTheshoulderisabductedandtheelbowiskeptflexedThereislossofthenormalcontour轮廓oftheshoulder当前11页，总共63页。ClinicalPictureLossofthecontouroftheshouldermayappearasastepAnteriorbulge膨胀ofheadofhumerusmaybevisibleorpalpableAgapcanbepalpatedabovethedislocatedheadofthehumerus当前12页，总共63页。XRayofDislocationofShoulder

当前13页，总共63页。AssociatedInjuriesofShoulderDislocationInjurytotheneurovascularbundleinaxilla(rare)Injuryof

theAxillary腋神经(Usuallystretchingleadingtotemporaryneuropraxia)Associatedfracture当前14页，总共63页。AxillaryNerveInjury腋神经伤AlsocalledcircumflexnerveItisabranchfromposteriorcordofBrachialplexusIthookscloseroundneckofhumerusfromposteriortoanteriorItpiercesthedeepsurfaceofdeltoid三角肌andsupplyitandthepartofskinoverit当前15页，总共63页。ManagementofShoulderDislocationIsanEmergencyItshouldbereducedinlessthan24hoursortheremaybeAvascularNecrosisofheadofhumerusFollowingreductiontheshouldershouldbeimmobilisedstrappedtothetrunkfor3-4weeksandrestedinacollarandcuff当前16页，总共63页。MethodsofReductionHippocratesMethod(Anesthesia麻醉isrequired)Stimpson’stechnique(Sedation镇静andAnalgesia止痛areused,butNoanesthesia)Kocher’stechniqueisthemethodusedinhospitalsundergeneralanesthesiaandmusclerelaxation当前17页，总共63页。HippocratesMethod当前18页，总共63页。Stimpson’stechnique当前19页，总共63页。Kocher’sTechnique当前20页，总共63页。ComplicationsofShoulderDislocation:EarlyNeurovascularinjury(rare)AxillarynerveinjuryAssociatedFractureofneckofhumerusorgreaterorlessertuberosities（肱骨结节）当前21页，总共63页。ComplicationsofShoulderDislocation:LateAvascularnecrosisoftheheadoftheHumerus(highriskwithdelayedreduction)Heterotopiccalcification(usedtobecalledMyositisOssificans)骨化性肌炎Recurrentdislocation当前22页，总共63页。FracturesofTheHumerusProximalHumerus:surgicalandanatomicalneckShaftofHumerusDistalhumerus当前23页，总共63页。FracturesofTheHumerus当前24页，总共63页。FractureProximalHumerus当前25页，总共63页。Intra-medullaryKwirefixation当前26页，总共63页。FracturesShaftoftheHumerusCommonlyIndirectIndirectinjuryresultsinSpiralorObliquefracturesDirectinjuriesresultsintransverseorcomminutedfractureMaybeassociatedwithRadialNerveinjury当前27页，总共63页。FractureshaftoftheHumerus当前28页，总共63页。Treatment:PlatingorNail当前29页，总共63页。FractureDistaloftheHumerus当前30页，总共63页。RadialNerveInjuryResultsinWristdropAssociatedwithfracture

humerusinupto12%offractures2/3(8%)ofRadialinjuryareNeuropraxia(神经失用)当前31页，总共63页。ManagementofRadialNerveInjuryWhenpresentinopenfractures;immediateexplorationand±repairInclosedinjuriestreatedconservatively;initialmanagementisdoingNerveConductionStudies(NCS)andElectromyography(EMG)andawaitingforspontaneousrecovery当前32页，总共63页。ManagementofRadialNerveinjuryRecoveryusuallystartsafterfewdaysbutmaytakeupto9monthsforfullrecoveryIfNospontaneousrecoveryoccursin12weeksconfirmedbyNCSandEMG;thenexplorationofthenerveshouldbecarriedout当前33页，总共63页。ManagementofHumerusShaftFractureMostofthetimeisConservativeClosedReductioninuprightpositionfollowedbyapplicationofUshapedSlaborCylindercastFewweekslaterorinitiallyinstablefracturesFunctionalBracemaybeused当前34页，总共63页。UShapedSlabofPOP当前35页，总共63页。FunctionalBrace功能支具当前36页，总共63页。IndicationsforORIF切开复位内固定Failuretoreducefractureconservatively保守失败Bilateralhumeralfractures双侧骨折OpenfracturewithradialnerveInjury开放骨折并神经伤Unconsciouspatient昏迷病人Delayed-Union延迟愈合Non-Union不愈合Mal-Union畸形愈合当前37页，总共63页。ORIF：openreduction

internalfixation当前38页，总共63页。Supra-condylarFractureofHumerus肱骨髁上骨折当前39页，总共63页。PediatricSupra-CondylarHumeralFracture当前40页，总共63页。PediatricSupra-condylarfracture当前41页，总共63页。Reductionofsupra-condylarFractureAbsoluteEmergencyShouldbedonebyexperienceddoctorassoonaspossibleInthepastthearmwasheldinflexedelbowpositioninback-slabPOPafterreductionAtpresenttimePercutaneousKwirefixationisALWAYS

carriedoutafterreduction当前42页，总共63页。ComplicationsSupra-CondylarFracturesEarly=Compartmentsyndrome（Volkmann‘sIschemia）

Late=Stiffness

Volkmann'sIschemicHeterotopicCalcification

Mal-Union(Valgusorvarus)当前43页，总共63页。Supracondylarfracture当前44页，总共63页。EblowDislocation肘关节脱位FootballWeightlifting当前45页，总共63页。ElbowReduction肘关节复位.当前46页，总共63页。FractureDislocation骨折脱位当前47页，总共63页。SubluxationofRadialHead桡骨小头半脱位当前48页，总共63页。SubluxationofRadialHead桡骨小头半脱位1.拇指按压桡骨小头处；2.将前臂作旋后或旋活动当前49页，总共63页。MonteggiaFracture-Dislocation

当前50页，总共63页。MonteggiaFractu