外科学下111the hand injury手外伤邓忠良.pptx

Hand InjuryZhong-Liang Deng MD, PhD, Prof.Dept. of OrthopedicsSecond Affiliated HospitalChongqing Medical UniversitySurface anatomy of the handTendons around the thumb form an anatomic snuff-box, which can be touched when the thumb is abducted and extended.Hand AnatomyExtensor Tendons:Courses over the dorsal side of the forearm, wrist and hand.9 extensor tendons pass under the extensor retinaculum and separate into 6 compartmentsHand AnatomyExtensor Tendons:The extensor tendons gain entrance to the hand from the forearm through a series of six canals, five fibroosseous and one fibrous The communis tendons are joined distally near the MP joints by fibrous interconnections called juncturae tendinum. Beneath the retinaculum, the extensor tendons are covered with a synovial sheath. Hand AnatomyExtensors digitorum communis are connected by junctura.Because of this, a complete tendon laceration proximal to the junction may still result in normal extensor function.Hand AnatomyFlexor Tendons:Courses over the volar side of the forearm, wrist, and hand.Unlike the extensor tendons, the flexor tendons are enclosed in synovial sheaths making them prone to deep space infections.Hand AnatomyFlexor Tendons:Flexor carpi radialis, flexor carpi ulnaris, and palmaris longus primarily flex the wristHand AnatomyPosture of hand at restRest positionHand functional postureFunctional positionHand Anatomy9 flexor tendons pass through the carpel tunnel:1 tendon goes to the base of the dist. Phalanx of the thumbThe other 4 digits have 2 tendons respectively (FDS / FDP).Hand AnatomyFlexor digitorum superficialis (FDS) insert into middle phalanx.Flexor digitorum profundus (FDP) runs deep to the FDS until the level of the MP joint where FDS bifurcates.FDP inserts at the base of the distal phalanx and acts primarily to flex the DIP joint as well as all other joints flexed by FDS. (Figure 268-5).Hand AnatomyBlood supply (BS):Hand and digits have dual (BS) contributed by the radial and ulnar arteri