上肢骨折和手外傷

ClavicleFractures

鎖骨骨折Anatomy第1頁，共50頁。CausesofClavicleFractureAccidentssuchasfalls

Sometimes,ablowfromabluntobjectoracollisionofsomesort第2頁，共50頁。FractureClassificationFractureofmiddle1/3(groupI)

accountfor80%第3頁，共50頁。frxofdistal1/3(groupII)

accountfor10-15%

typeI:minimaldisplacement

typeII:frxmedialtocoracoclavicularligaments

typeIII:articularsurfacefractures

frxofmedial1/3(groupIII)accountfor5%第4頁，共50頁。SymptomsofClavicleFracturePainSwellingTendernessDeformityInternalbleedingIfaskedtolifttheirarm,patientswithabrokenclaviclecannotdosowithoutextremepain.第5頁，共50頁。TreatmentofClavicleFracture

Thegoaloftreatingbrokenbonesistosetthem,makingthemwholeagainfigure-8splintorstrapimmobilizedfor6-8weeksOpenreductionandinternalfixation第6頁，共50頁。HumerusShaftFractures

肱骨干骨折第7頁，共50頁。CausesofHumeralShaftFractureDirectstress,suchasablowtothearm.Indirectforces,suchasafall,twistingortorsionalforces.

第8頁，共50頁。mechanismbendingforceproducestransversefrxoftheshaft;torsionforcewillresultinaspiralfracture;combinationofbendingandtorsionproduceobliquefrxw/orw/oabutterflyfragment;compressionforceswillfrxeitherproximalordistalendsofhumerus;

第9頁，共50頁。typesofhumeralshaftfractureTransversehumeralfracturesShortobliquefracturesLongspiralfractures第10頁，共50頁。SymptomsofhumeralshaftfracturePainLossofstrengthinthegripSwellDeformityTenderness

Ifthebloodsupplyisimpaired,theremaybenumbnessandcoldnessinthearmandhand.第11頁，共50頁。NonOperativeTreatmentofHumeralShaftfractureLongarmsplintneedstobeappliedfromshouldertowristtofullyimmobilizetheextremity;第12頁，共50頁。OperativeTreatment:internalfixationshouldbereservedforfractureswithinadequatereductionorpatientswithmultipletrauma;第13頁，共50頁。IMNailingofHumeralShaftFractures第14頁，共50頁。PlateFixation第15頁，共50頁。AnatomySupracondylarFracture

oftheHumerus

肱骨髁上骨折第16頁，共50頁。CausesByafall

Thechildmaystretchouthisorherhandandtheforcefromtheimpactmaybeenoughtocauseabreakinthebone.

Butanytraumatothearea,suchasaninjuryfromacaraccident,mayalsobeacause.

第17頁，共50頁。-typeI:non-displacedfrx-typeII:displacedwithintactposteriorcortex-typeIII:displacedwithnocorticalcontact第18頁，共50頁。Symptomspainintheelbowswellingintheelbowinabilitytomovethearmduetopain第19頁，共50頁。ComplicationscompartmentsyndromeVolkmann‘scontracturemedianorulnarnerveinjurystiffnessangulationmyositisossificans第20頁，共50頁。TreatmentCase1第21頁，共50頁。Case2第22頁，共50頁。Bothboneforearmfractures

前臂雙骨折第23頁，共50頁。ClassificationBothBoneForearmFracturesLocationProximal,middle,distalthird,epiphysealSkinIntegrityOpen,ClosedFracturePatternSamelevel,differentlevel,associatedjointdisruption

MonteggiaFractures

GaleazziFracturesDisplacementRotation,translation,shortening,interosseousspaceSkeletalMaturityMaturevsimmature第24頁，共50頁。Case1:42yearoldmaninjuredinacaraccident.Hisleftarm第25頁，共50頁。Case2第26頁，共50頁。CollesfractureSmithfractureDistalradiusFracture

橈骨遠(yuǎn)端骨折第27頁，共50頁。ClassificationofdistalradiusfracturesIDorsaldisplacedCollesfracturesIIPalmardisplacedSmithfracturesIIIComminutedfractures第28頁，共50頁。(1.)DistractionwithexternalfixationsupplementedwithpercutaneousKirschnerwires.(2.)Distractionusingatemporaryplateandscrews,tunnelledbetweentwosmallaccessincisions.(3.)Openreductionwithabuttressplate.(4.)OpenreductionwiththeMedofffixationsystem.Fixationofdistalradiusfractures第29頁，共50頁。ComplicationReflexsympatheticdystrophy;fingerstiffness;ulnarstyloidnonunion;Carpaltunnelsyndrome;posttraumaticarthritis;tendonrupturecarpalinstability第30頁，共50頁。Case1This60yearoldwoman.Shewastreatedwithclosedreductionandpinning.Treatment第31頁，共50頁。Case2PreopPostop第32頁，共50頁。TheInjuredHand手外傷第33頁，共50頁。Arteriesofhand第34頁，共50頁。Nervesofhand第35頁，共50頁。ExaminationoftheInjuredHandAtrest,fingertipsnormallyfallintoacascadepostureofincreasingflexionfromtheindextothesmallfinger.第36頁，共50頁。Flapsforfingertipreconstruction(1.)PalmarV-Yneurovascularislandadvancementflap.(2.)Dorsalcrossfingerflap.(3.)Thenarflap.

第37頁，共50頁。TendonInjury肌腱損傷第38頁，共50頁。flexortendons第39頁，共50頁。flexortendonzones1:digitalsheathcontainingonetendon;2:digitalsheathcontainingtwotendons("noman'sland")3:palm;4:carpaltunnel;5:theforearm."noman'sland"第40頁，共50頁。TendonSuture第41頁，共50頁。Scaphoidfractures

舟骨骨折第42頁，共50頁。XraybeforetwomonthspostoptwomonthspostopXraybefore第43頁，共50頁。IntraarticularMetacarpalbasefractures

關(guān)節(jié)內(nèi)掌骨基底骨折Bennett'sandreversedBennett'sfractures.第44頁，共50頁。MetacarpalNeckFractures

掌骨頸部骨折Boxer'sfracture

第45頁，共50頁。Phalangealfractures

指骨骨折第46頁，共50頁。middlephalanxbasefractureDorsalfracturedislocation

palmarfracturedislocation

第47頁，共50頁。Unicondylarphalanxheadfractures

指骨頭部骨折第48頁，共50頁。第49頁，共50頁。內(nèi)容梗概ClavicleFractures

鎖骨骨折。Byafall。Bothboneforearmfractures

前臂雙骨折。DistalradiusFracture

橈骨遠(yuǎn)端骨折。closed