粗隆间骨折--DHS.ppt

* LESSER TUBEROSITY AP pelvis and AP hip of an elderly patient with a three-part intertrochanteric hip fracture. LATERAL RADIOGRAPH The set up on the fracture table does not require the uninjured leg to be placed in hyperflexion and abduction. The legs may be scissored to allow for good lateral radiographs of the affected side without putting the opposite hip at risk. ISCHIUM LESSER TROCHANTER FEMUR This image demonstrates the position of the fracture table with the patient’s affected arm over the chest and well padded. SCDs ON DURING PROCEDURE This image demonstrates the scissoring of the legs with the affected side slightly flexed and the unaffected side slightly extended. Notice that sequential compression devices remain on the legs during the procedure. A view from below demonstrates the position of the arm. The C-arm is brought in from an angle approximately 30 degrees distal to the patient. The AP radiograph is taken with the C-arm slightly over rotated to give a more perfect AP view with respect to the anatomy of the proximal femur and the lateral view. The incision should begin proximally at the trochanteric ridge and need extend approximately 10 centimeters down the thigh. ITB The incision brought down to the level of the iliotibial band and fascia lata. ITB The iliotibial band is incised with a knife. A Metzenbaum scissors is used to dissect under the band, which is divided in line with the incision. The iliotibial band is incised with a knife. A Metzenbaum scissors is used to dissect under the band, which is divided in line with the incision. With retraction of the iliotibial band, the vastus lateralis fascia is visualized. VASTUS LATERALIS ITB A sharp rake is introduced anteriorly and is used to retract the vastus lateralis anteriorly. An incision is then made in the fascia just anterior to the most posterior aspect of the femur. A sharp rake is introduced anteriorly and is used to retract the vastus lateralis anteriorly. An incision is the