股骨干骨折骨折ppt课件.ppt

Do not discuss nonunion, this will be covered later in the course. Discuss causes of delay in union. Describe the biologic and mechanical condition at the fracture. - Unstable but viable. It is trying to heal, it needs only stability. Describe methods to provide stability at this point. Exchange nailing? Dynamization? * Discuss radiographic and clinical signs and symptoms of bone healing. How does dynamization help? - Allows the bone ends to compress, providing stability which promotes healing. Which end to dynamize and why? - Usually dynamize the screw farthest from the fracture to help maintain stability. * * Results at 18 and 24 weeks postoperative. Describe the radiographic changes. * Ask participants to summarize the case discussion. Discussion points: How do you classify this fracture? – 32-A1 * Discussion points: IM nailing or plate fixation - as often both fixation techniques have pros and cons Reduction techniques? Type of stability? * * * Ask participants to summarize the case discussion. * How would you classify this fracture? Click after each answer to show results: Bone? - femur (3) Segment: Proximal (1), diaphyseal (2), or distal (3)? - diaphyseal (2) What type: Extraarticular (A), partial articular (B), complete articular (C)? - extraarticular (A) Which group: Simple spiral (A1)? Simple oblique (A2)? Simple transverse (A3)? - simple oblique (A2) Classification: 32-A2 * Is reduction adequate? - Yes, reduction of length, rotation and alignment achieved. What is this implant? - LISS fixator How does it function? - As a bridge plate for relative stability. Are these monocortical screws adequate? - Not in osteoporotic bone. Bicortical screws provide much greater construct stiffness. * * Ask participants to describe some parameters of healing. Radiographic callus bridging fracture No implant loosening or breakage No pain Full ROM What should be done for the patient’s osteoporosis? - Comanagement of osteoporosis is essential t