10手创伤.ppt

03/04/2014 手部骨与关节损伤处理 Consider Open Reduction and Internal Fixation (ORIF) Advantages Avoid excessive manipulation Avoids prolonged splinting Indications Unstable displaced intra-articular fractures if 25-30% of joint surface involved 03/04/2014 03/04/2014 Prognosis Replantation What is replantation? Replantation refers to the surgical reattachment of a finger, hand, or arm that has been completely cut from a person’s body. 03/04/2014 The goal of replantation surgery to give the patient back as much use of the injured area as possible. In some cases, replantation is not possible because the part is too damaged. If the lost part cannot be reattached, a patient may have to use a prosthesis (a device that substitutes for a missing part of the body). In some cases, a prosthesis may give a person without hands or arms the ability to function. 03/04/2014 First Aid Stop bleeding Reduce contamination Protect Limb/finger Transportation to a hospital 03/04/2014 Indications of replantation Replantation is usually recommended when the replanted part will work at least as well as a prosthesis. Generally, a missing hand would not be replanted knowing that it would not work, be painful, or get in the way of everyday life. Before surgery the doctor, if possible, will explain the procedure and how much use is likely to return following replantation. The patient or family member must decide whether that amount of use justifies the long and difficult operation, time in the hospital, and months or years of rehabilitation. 03/04/2014 Treatment after replatation The patient has the most important role in the recovery process. Smoking causes poor circulation and may cause loss of blood flow to the replanted part. Allowing the replanted part to hang below heart level may also cause poor circulation. Younger patients have a better chance of their nerves growing back, they may regain more feeling, and may regain more movement in the replanted part. 03/04/2014 Prognosis Genera