(外科学课件）04-2017-上肢骨折-02宣讲培训.pptVIP

Key points Indications of the Open Reduction and Internal fixation for a close Fracture Complications of the fractures: humeral shaft, supracondyle Deformity of the Colles Fracture, Baton Fracture Definition of Monteggia fracture and Galeazzi fracture Open reduction and internal fixation Section II-Part I Part I: Fractures of shaft of radius and ulna Two bones There is a interosseous membrane between the bones Five joints: radiohumeral, ulnohumeral, proximal radioulnar, radiocarpal and distal radioulnar joints. These joints make it possible for the radius to rotate by rolling over the ulnar Anatomy of forearm Mechanism With a direct blow you can break either isolated, however more likely indirect blow to damage both. Pain,crepitus,swelling secondary to fracture hematoma and soft-tissue injury. Apparent deformity:results from the high energy and the multitude of deforming muscle force. Skin:should be throughly inspected for any breaks that may communicate with fracture. Clinical features More severe swelling Tense forearm compartments Pain out of proportion to the injury Pain with passive extension of fingers Any signs of compartment syndrome warrants immediate fasciotomy Compilcation-compartment syndrome Radiographic evaluation Direct force X ray Two special fractures of forearm Monteggia fracture Galeazzi fracture Monteggia Monteggia fracture: proximal 1/3 fracture of ulnar associated with radial head dislocation. Galeazzi Galeazzi fracture: distal 1/3 fracture of radial shaft associated with distal radioulnar joint dislocation. Treatment Open reduction and internal fixation： Compression plate and screws Intramedullary fixation Compression plate and screws Segmental fractures of diaphysis of forearm Intramedullary fixation Fracture of distal end of radius Most commonly women age 60-70. 90% caused by compression on dorsiflexed wrist. 90% of distal radius fractures are Colles Fractures Fracture of distal end of radius Definition