医学精品课件：外科upper extremity fracture.ppt

1、,Liangxi 梁熙 The first affiliatied hospital of Chongqing medical university,Upper Extremity Fracture,Upper limb is the organ of labor, it is composed by should ,armpit, brachium, forearm and hand. Bone that compose upper limb: The girdle of upper limbclavicle and scapular The free bone of upper limbh

2、umerus, radius, ulna, carpale、metacarpal, phalange.,Bones that compose upper limb: The girdle of upper limbclavicle and scapular The free bone of upper limbhumerus, radius, ulna, carpale、metacarpal, phalange,fracture of clavicle,clavicle,The general view of anatomy ：The shape is “S” proximal end ste

3、rnum clavicular joint distal end scapular clavicular joint,etiological factor and classification ：indirect force，fall on laterally should touch on the ground force transit to the clavicle oblique fracture. classification : oblique 、transverse, comminuted fracture; the fractures of children usually a

4、re greenstick fractures.,the displacement of the fracture piece : the proximal end of the fracture displace superiorly and posteriorlly because of the traction of the Sternocleidomastoideus muscle, the distal end of the fracture displace anteriorlly and inferiorly - weight of upper limb and the trac

5、tion of pectoralis major,Sternocleidomastoideus muscle,clinical manifestation and diagnosis ： 1.the location of the fracture is , swell, pain, ecchymosis, the affected should is drooping, head lean to affected side of the body, patient always protect the affected limb with opposite limb in order to

6、relieve pain. 2. tenderness，the fracture can be touched.,Diagnosis The history of trauma clinical manifestation , X-ray,Treatment ： 1、greenstick fracture and nondisplaced fracture sling with triangular bandage for 36 weeks,Treatment,2、displaced fracture - manipulative reduction and immobilization of

7、 lateropulsition 8 shape bandage,Treatment,3、open reduction and internal fixation,fracture of surgical neck of humerus,The general view of anatomy：inferior to the anatomical neck of humerus 2-3cm, just locate in the intersection of the compact bone and spongy bone, so it is ease to be fractured. . .

8、,there are brachial plexus and axil vessels medially to the surgical neck of humerus, its possible to be injuried,etiological factor and classification ：indirect force is the most causes of fracture, the main cases are adults and old people,classification: according to the displacement and the direc

9、tion of displacement, the fractures can be classified. (1) No displacement type fracture (2) abduction type fracture (3) Adduction type fracture (4) comminuted type fracture,No displacement,Abducr fracture,Adduct fracture,comminuted type fracture,(一) non displacement fracture： classification 1. fiss

10、ured fracture caused by direct violence mostly. 2. compact fracture caused by indirect violence mostly. clinical manifestation： pain, swell, ecchymosis, dysfunction of the shoulder. diagnosis: the history of trauma clinical manifestation x ray,non displacement fracture treatment：sling with triangula

11、r bandage, and early exercise,(二) abduction type fracture indirect violence hand touch on the ground violent transmit along the limb the affected limb abduct abduction type fracture. clinical manifestation：pain, swell, ecchymosis, dysfunction of the shoulder. X film: the proximal fracture piece addu

12、ct, the distal fracture piece abduct, angulation displacement or lateral displacement, or overlap displacement.,diagnosis: the history of trauma, clinical manifestation and x ray. . Pay attention to injury of nerve and blood vessels,treatment： 1. local anesthesia and manipulative reduction, external

13、 fixation with splint.,2. open reduction and internal fixation.,(三) Adduction type fracture fall down with the hand and elbow touch on the ground violence transmit to the should along the axis of the arm. clinical manifestation：swell, ecchymosis, dysfunction of the shoulder. X film: the proximal fra

14、cture piece abduct, the distal fracture piece adduct, angulation displacement or lateral displacement, or overlap displacement. .,diagnosis: the history of trauma clinical manifestation and x ray. Pay attention to injury of nerve and blood vessels,treatment： local anesthesia and manipulative reducti

15、on, external fixation with splint, should abduct 70with abduct frame.,2. Open reduction and internal fixation,(四) comminuted fracture strong violence and osteoporosis, most cases are old patients. clinical manifestation：pain, swell, ecchymosis, dysfunction of the shoulder. X ray show the number, the

16、size and the location of the fracture pieces.,diagnosis : the history of trauma clinical manifestation and x ray Pay attention to injury of nerve and blood vessels,treatment： 1. conservative treatment：sling with triangular bandage or bone traction and splint fixation. 2. operation treatment：open red

17、uction and fixation with screw and plate,The fracture of humeral shaft,The outline of anatomy : humeral shaft is originate from the point that is 1cm inferior to the surgical neck to the point that is 2cm superior to the humeral epicondely. There is groove of radial nerve posterior laterally to the

18、midlle third of the humeral shaft. The radial nerve is easy to be injuried there.,Causes of injury: direct violence transverse or comminuted fracture. indirect violence oblique or spiral fracture,The relationship among the displacement and the site of fracture , the traction of muscles. Superior to

19、deltoid muscle insertion site muscles direction of pacement Proximal fracture piece pectoralis major medial and anterior latissimus dorsi, teres major Distal fracture piece deltoid muscle coracobrachialis lateral and superior biceps , triceps,Inferior to deltoid muscle insertion site muscles directi

20、on of pacement Proximal fracture piece deltoid muscle anterior and lateral Distal fracture piece biceps, triceps superior,clinical manifestation: pain, swell, ecchymosis, dysfunction of the upper limb. PE: tenderness, shortness of the upper limb, angulation, abnormal motion, bony crepitus. x-ray can

21、 make sure the type of the fracture and the direction of the movement.,If complicate radial nerve injury, the patient has wrist drop, metacarpophalangeal joints can not extend, lateral side of the back of hand has sensory disability.,diagnosis: the history of trauma, clinical manifestation and x ray

22、. Concentrate on nerve injury.,treatment： 1、conservative treatment： 1) manipulative reduction, 2) external fixation with splint or plaster. 3) avoid radial nerve injury,2、operation treatment：open reduction and fixation with screw and plate. 3、 early exercise,humeral supracondylar fracture .,The outl

23、ine of anatomy: the supracondyle of humerus is flat and wide, the anterior is coronoid fossa, the posterior is olecranon fossa, the bone beween these two fossas is thin that make it is to be fractured. There are brachial artery and vein, median nerve anteriorly and medially to the humeral condyle. T

24、hese blood vessels and nerve just under the bicipital fascia (aponeurosis) are easy to be injuried or compressed,The ulnar nerve that is medial to the humeral condyle and radial nerve that is lateral to the humeral condyle are also easy to be injuried.,The epiphyseal plate of children can be injurie

25、d that result in abduction or adducrion with the childrens growth,Classification: 1. flexion type fracture 2. straight type fracture,(一) straight type fracture etiological factor：indirect violence fall hand touched ground violence transmit to the distal humerus the humeral condyle is pushed to poste

26、rior superiorly ；meanwhile the weight push the humeral shaft anterior inferiorly, then the weakness of the humeral supracondyle is broken, radialis or ulnaris displacement result from the lateral or medial direction violence,clinical manifestation: swell, ecchymosis, dysfunction of the upper limb. P

27、E: tenderness, short of the upper limb, angulation, abnormal motion, bony crepitus. Fracture ends can be touched, outer margin of elbow is normal Must pay attention to nerves and vessels injury. (ulnar nerve, radial nerve, brachial artery) x ray can make sure the type of the fracture and the directi

28、on of the movement,（二）flexion type fracture etiological factors ：fall outer margin of elbow touch on the ground violence transmit to the distal humerus and cause fracture. 。,clinical manifestation: pain, swell, ecchymosis, dysfunction of the upper limb. PE: tenderness, the upper limb short is short

29、(overlap) , angulation, abnormal motion, bony crepitus. Fracture ends can be touched posteriorly to the outer margin of elbow , triangle of outer margin of elbow is normal. Must pay attention to nerves and vessels injury. x ray can make sure the type of the fracture and the direction of the movement

30、,diagnosis: the history of trauma, clinical manifestation, nerve and blood vessels injury x ray,treatment： 1. conservative treatment local anesthesia, manipulative reduction, external fixation with splint or plaster and elbow flex 40 2. open reduction,Fracture of ulna and radius,The outline of anato

31、my: forearm is composed by ulna and radius, the proximal ulna end is important part of elbow joint, the distal radius end is important part of wrist joint.,The bones is connectecd by proximal radioulnar joint, distal radioulnar joint and interosseous membranes of forearm. Rotation of the forearm is

32、the associated motion of distal and proximal radioulnar joint. Ulna is axis of the rotation. Width between the ulna and radius is important for rotation, when the forearm is in neutral position, the width is 1.52.0cm and the widest,Lots muscle attach to ulna and radius, so displacement of fracture p

33、ieces is complex that make reduction very difficult.,pronator teres,supinator,Interosseous membranes,pronator quadratus,etiological factor and classification 1、direct violence ：fractures are at the same plane. 2、indirect violence ：transverse fracture or oblique fracture, radial fracture plane is upp

34、er than ulnar. 3、torsional violence: spiral fracture or oblique fracture. radial fracture plane is lower than ulnar.,Direct violence,Indirect violence,Torsional violence,Clinical manifestation and diagnosis: the forearm is swell, tenderness, deformity, abnormal motion, bony crepitus, dysfuction. Mon

35、teggia fracture: fracture of proximal 1/3 ulna associate with radial head dislocation. Galeazzi fracture: fracture of distal 1/3 radius associate with ulnar head dislocation.,Monteggia fracture,Galeazzi fracture,Treatment ： (1) reduction and external fixation (2) open reduction manipulative and fixa

36、tion with screw and plate (3) functional exercise,Fracture of distal radius,out line of anatomy: the fracture of distal radius occurs approximately 3cm proxomal to the articular surface of the distal radius. This area is the intersection of cortical and cancellous bone, for this anatomical factor th

37、e distal radius can be broken easily.,The normal distal radius articular surface inclines ulnarly between 2025, inclines palmarlly between 1015.,etiological factor: main cause is indirect violence. Classification: because of the different mechanism of injury, the type of fracture is different. 1. st

38、raight type fracture 2. flexion type fracture 3. articular surface fracture associated with wrist dislocation,(一) straight type fracture (Colles fracture) it happens when wrist extends and forearm pronate and hand touches ground. .,clinical manifestation and diagnosis： pain, swell, tenderness, “fork

39、 shape” deformity, “rifle bayonet” deformity, dysfunction of wrist joint. Distal fracture piece displace to radius and dorsal forward. X ray find distal fracture piece displace radial dorsally,rifle bayonet,fork shape,Treatment： 1、manipulative reduction and external fixation,2、open reduction and int

40、ernal fixation.,(二) flexion type fracture (Smith fracture) it happens when wrist flexion and back of hand touches on the ground.,Manifestation and diagnosis: wristdrop, swell, ecchymosis, dysfunction of wrist joint , X ray find distal fracture piece displace to ulna and palm forward. Also called rev

41、erse Colles fracture.,treatment： manipulative reduction and external fixation.,Open reduction and internal fixation,(三) articular surface fracture associated with wrist dislocation Wrist dislocation and the dorsa or palm of distal radial articular surface is broken result from different gesture. 1. barton fracture 2. reverse barton fracture,Barton fracture,Reverse barton fracture,Treatment: manipulative reduction and external fixation, if the fracture is unstable, open reduction and internal fixation can be applied.,