前臂双骨折的手术入路要点.ppt

This image demonstrates the reduced fracture, viewed from the volarly. This image shows that the fracture is also compressed on the opposite side due to proper contouring of the plate. Once the radius is fixed, the ulna is approached using a standard subcutaneous longitudinal incision with the arm flexed, as seen in the next image. These images demonstrate the superficial dissection down to the fascia directly over the ulna, which is the common fascia between the flexor carpi ulnaris and the extensor carpi ulnaris. This is divided in line with the muscles directly over the subcutaneous border of the ulna. ECU EXTENSOR CARPI ULNARIS FCU FLEXOR CARPI ULNARIS A periosteal elevator is used to clean the external surface of the ulna. This is cleaned, reduced and fixed in exactly the same fashion as the radius was, using a 6-hole DCP plate and in compressive mode. These images show the plate in place with screw holes, allowing for compression in the final compressed fracture. Intraoperative fluoroscopic views demonstrate accurate reduction and appropriate length of screws. Postoperative AP and lateral views demonstrating anatomic reduction and alignment of the radius and ulna. 五附院骨二科 骨二科学习 AP and lateral views of the both bones fracture of the forearm, demonstrating significant shortening and relatively simple oblique fracture patterns. The patient is positioned supine with the arm prepped and draped to just above the elbow and a tourniquet in place. This figure demonstrates the arm held in supination. Note the position of the biceps insertion as well as the palpable tendon of the FCR and radial artery. BICEPS TENDON RADIAL ARTERY FLEXOR CARPI RADIALIS (FCR) A useful technique to make the skin incision is to take a bovi cord and pull it taught from the radial side of the biceps tendon to the FCR at the level of the wrist. This can then be used as a template for the incision line. The incision is taken down through the skin, identifying the fascial layer with c