上肢骨折与关节损伤演示文稿

上肢骨折与关节损伤演示文稿现在是1页\一共有62页\编辑于星期三（优选）上肢骨折与关节损伤现在是2页\一共有62页\编辑于星期三Mechanism损伤机制MostlyIndirectCommonlydescribedas“afallonoutstretchedhand“Typeofinjurydependsonpositionoftheupperlimbatthetimeofimpact:Flexed屈曲,Extended伸直,Adducted内收,Abducted外展,Pronated旋前orSupinated旋后现在是3页\一共有62页\编辑于星期三FractureoftheClavicle锁骨骨折CommonespeciallyinchildrenandelderlyCommonestsiteisthemiddleonethirdMainlyduetoindirectinjuryDirectinjuryleadstocomminutedfracture现在是4页\一共有62页\编辑于星期三现在是5页\一共有62页\编辑于星期三TreatmentConservativebyanarmsling手臂吊带oreightbandage八字绷带Operativefixationisindicatedifthereisanopenfracture,neurovascularinjuryornonunion现在是6页\一共有62页\编辑于星期三FigureofeightBandage8字固定带现在是7页\一共有62页\编辑于星期三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钩钢板现在是8页\一共有62页\编辑于星期三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现在是9页\一共有62页\编辑于星期三Mechanism机制UsuallyIndirectfallonAbductedandextendedshoulderMaybedirectwhenthereisablowontheshoulderfrombehind现在是10页\一共有62页\编辑于星期三AnteriorShoulderdislocationUsuallyalsoinferiorBankart’sLesion前盂唇损伤现在是11页\一共有62页\编辑于星期三ClinicalPicturePatientisinpainHoldstheinjuredlimbwithotherhandclosetothetrunkTheshoulderisabductedandtheelbowiskeptflexedThereislossofthenormalcontour轮廓oftheshoulder现在是12页\一共有62页\编辑于星期三ClinicalPictureLossofthecontouroftheshouldermayappearasastepAnteriorbulge膨胀ofheadofhumerusmaybevisibleorpalpableAgapcanbepalpatedabovethedislocatedheadofthehumerus现在是13页\一共有62页\编辑于星期三XRayofDislocationofShoulder

现在是14页\一共有62页\编辑于星期三AssociatedInjuriesofShoulderDislocationInjurytotheneurovascularbundleinaxilla(rare)Injuryof

theAxillary腋神经(Usuallystretchingleadingtotemporaryneuropraxia)Associatedfracture现在是15页\一共有62页\编辑于星期三AxillaryNerveInjury腋神经伤AlsocalledcircumflexnerveItisabranchfromposteriorcordofBrachialplexusIthookscloseroundneckofhumerusfromposteriortoanteriorItpiercesthedeepsurfaceofdeltoid三角肌andsupplyitandthepartofskinoverit现在是16页\一共有62页\编辑于星期三ManagementofShoulderDislocationIsanEmergencyItshouldbereducedinlessthan24hoursortheremaybeAvascularNecrosisofheadofhumerusFollowingreductiontheshouldershouldbeimmobilisedstrappedtothetrunkfor3-4weeksandrestedinacollarandcuff现在是17页\一共有62页\编辑于星期三MethodsofReductionHippocratesMethod(Anesthesia麻醉isrequired)Stimpson’stechnique(Sedation镇静andAnalgesia止痛areused,butNoanesthesia)Kocher’stechniqueisthemethodusedinhospitalsundergeneralanesthesiaandmusclerelaxation现在是18页\一共有62页\编辑于星期三HippocratesMethod现在是19页\一共有62页\编辑于星期三Stimpson’stechnique现在是20页\一共有62页\编辑于星期三Kocher’sTechnique现在是21页\一共有62页\编辑于星期三ComplicationsofShoulderDislocation:EarlyNeurovascularinjury(rare)AxillarynerveinjuryAssociatedFractureofneckofhumerusorgreaterorlessertuberosities（肱骨结节）现在是22页\一共有62页\编辑于星期三ComplicationsofShoulderDislocation:LateAvascularnecrosisoftheheadoftheHumerus(highriskwithdelayedreduction)Heterotopiccalcification(usedtobecalledMyositisOssificans)骨化性肌炎Recurrentdislocation现在是23页\一共有62页\编辑于星期三FracturesofTheHumerusProximalHumerus:surgicalandanatomicalneckShaftofHumerusDistalhumerus现在是24页\一共有62页\编辑于星期三FracturesofTheHumerus现在是25页\一共有62页\编辑于星期三FractureProximalHumerus现在是26页\一共有62页\编辑于星期三Intra-medullaryKwirefixation现在是27页\一共有62页\编辑于星期三FracturesShaftoftheHumerusCommonlyIndirectIndirectinjuryresultsinSpiralorObliquefracturesDirectinjuriesresultsintransverseorcomminutedfractureMaybeassociatedwithRadialNerveinjury现在是28页\一共有62页\编辑于星期三FractureshaftoftheHumerus现在是29页\一共有62页\编辑于星期三Treatment:PlatingorNail现在是30页\一共有62页\编辑于星期三FractureDistaloftheHumerus现在是31页\一共有62页\编辑于星期三RadialNerveInjuryResultsinWristdropAssociatedwithfracture

humerusinupto12%offractures2/3(8%)ofRadialinjuryareNeuropraxia(神经失用)现在是32页\一共有62页\编辑于星期三ManagementofRadialNerveInjuryWhenpresentinopenfractures;immediateexplorationand±repairInclosedinjuriestreatedconservatively;initialmanagementisdoingNerveConductionStudies(NCS)andElectromyography(EMG)andawaitingforspontaneousrecovery现在是33页\一共有62页\编辑于星期三ManagementofRadialNerveinjuryRecoveryusuallystartsafterfewdaysbutmaytakeupto9monthsforfullrecoveryIfNospontaneousrecoveryoccursin12weeksconfirmedbyNCSandEMG;thenexplorationofthenerveshouldbecarriedout现在是34页\一共有62页\编辑于星期三ManagementofHumerusShaftFractureMostofthetimeisConservativeClosedReductioninuprightpositionfollowedbyapplicationofUshapedSlaborCylindercastFewweekslaterorinitiallyinstablefracturesFunctionalBracemaybeused现在是35页\一共有62页\编辑于星期三UShapedSlabofPOP现在是36页\一共有62页\编辑于星期三FunctionalBrace功能支具现在是37页\一共有62页\编辑于星期三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畸形愈合现在是38页\一共有62页\编辑于星期三ORIF：openreduction

internalfixation现在是39页\一共有62页\编辑于星期三Supra-condylarFractureofHumerus肱骨髁上骨折现在是40页\一共有62页\编辑于星期三PediatricSupra-CondylarHumeralFracture现在是41页\一共有62页\编辑于星期三PediatricSupra-condylarfracture现在是42页\一共有62页\编辑于星期三Reductionofsupra-condylarFractureAbsoluteEmergencyShouldbedonebyexperienceddoctorassoonaspossibleInthepastthearmwasheldinflexedelbowpositioninback-slabPOPafterreductionAtpresenttimePercutaneousKwirefixationisALWAYS

carriedoutafterreduction现在是43页\一共有62页\编辑于星期三ComplicationsSupra-CondylarFracturesEarly=Compartmentsyndrome（Volkmann‘sIschemia）

Late=Stiffness

Volkmann'sIschemicHeterotopicCalcification

Mal-Union(Valgusorvarus)现在是44页\一共有62页\编辑于星期三Supracondylarfracture现在是45页\一共有62页\编辑于星期三EblowDislocation肘关节脱位FootballWeightlifting现在是46页\一共有62页\编辑于星期三ElbowReduction肘关节复位.现在是47页\一共有62页\编辑于星期三FractureDislocation骨折脱位现在是48页\一共有62页\编辑于星期三SubluxationofRadialHead桡骨小头半脱位现在是49页\一共有62页\编辑于星期三SubluxationofRadialHead桡骨小头半脱位1.拇指按压桡骨小头处；2.将前臂作