外科學(xué)-骨折總論1(英文)

Orthopaedics

Generalaspectspart1

Orthopedics

GeneralAspectsofFracturesFracturesofUpperExtremityFracturesofLowerExtremityWhatisorthopedicsabout?ORTHOPAEDIANicolasAndry1741orthopaedicsOrtho-straightPaedion-child

Howtolearnorthopedics？Payattentiontothecharacteristicofthelocalanatomicstructures

Bone,muscle,tendon,fascia,nerve,bloodvesselPayattentiontothesystemiceffectsAssociatetheclinicalfindingswithradiographicexaminationWhatisorthopedicsabout?

Orthopedicsisaspecialtyofdiagnosingandmanagementtothemusculoskeletaldisease,abnormalitiesandtrauma.

Musculoskeletalsystem：supportandmovement

Trauma,Abnormalities,Inflammation,TumorandDegenerativediseaseGeneralAspectsofFractures1.Thedefinition,cause,classificationanddisplacementoffractures2.Theclinicalfindingsandradiographicexaminationofthefractures3.Thefracturehealingprocess4.Factorsinfluencingbonehealing5.FirstaidoffracturesGeneralAspectsofFractures6.Principlesintreatmentoffractures7.Treatmentofopenfractures8.Principlesintreatmentofopenjointsinjuries9.Complicationsoffractures10.Treatmentofdelayedunion,nonunionandmal-union

(一)TheDefinitionofFracturesDefinition：thecontinuityorintegrityofalivingbonehasbeenbroken1.fracture＝broken2.skeleton：thelossofmechanicalsupportingfunction3.local：softtissueinjuries－－bloodvessel、nerves、

muscles、fascia、skin4.thewholebody：shock、othervisceralinjuries(二）TheCausesofFracturesTraumaticDirectforce－localsofttissueinjuriesIndirectforce－thereisaconductionAccumulatedphysicalforcelongtime,repeated,slightPathologicaprimarydisease＋aslightforce

TraumaticFractures:DirectForce

TraumaticFractures:IndirectForce

TraumaticFractures:IndirectForceAccumulatedphysicalforcePathologic

Angulationlateralshortenedsegregatedrotation※（三）DisplacementofFragments

TheDisplacementFactorsThecharacteroftheforceThetractionofthemusclesTheweightoftheextremitiesImpropertransportationandtreatmentTheClassificationofFracturesTheintegrityoftheskinandmuscles

Thedegreeandshapeoffractures

Thestabilityofthebrokenparts

Theintegrityoftheskinandmuscles

Whethertheboneisexposedthroughasofttissuewound?

Closedfracture:theskinandmusclesatthefracturesiteisintact1pubicfracturewithrearurethrabreakage2rectumbreakagecausedbycoccygeusfracture

TheClassificationofFracturesOpenfracture:directlyorindirectlyopentoaseveredamagetosofttissuelackofcoverageeasilyinfectedinsufficientblood

slowtoheal

－aworseprognosis

ClosedFracture

TheHighriskOpenFractureSites

forearmandcrus

Thebadprognosisoftheopenfracture

TheClassificationofFractures※（二）TheDegreeandShapeofFracturesIncompleteFracturecrackfracturegreenstickfractureCompleteFractureTransversefractureObliquefracturespiralfracturecomminutedfractureimpactedfracturecompressionfractureepiphysealseparation/epiphysiolysis

（三）ThestabilityoffracturesStablefractureCrackgreenstickTransverseCompressionimpactedUnstablefractureobliquefracturespiralfracturecomminutedfracture

IncompleteFracture

greenstickfractureAO/ASIFAOArbeitsgemeinschaftfurOsteosynthesefragenASIFTheAssociationfortheStudyofInternalFixationNovember6,1958,HotelElite,Biel(Bienne),SwitzerlandTheClassificationofFractures(AO)MauriceE.Müller1988TheClassificationofFractures(AO)123123ABC123123骨節(jié)段部位型組亞組形態(tài)部位由近及遠(yuǎn)編號1234-.骨節(jié)段型組亞組部位形態(tài)

—.

骨節(jié)段

型組

亞組1231112223334類型

骨干(2)關(guān)節(jié)周圍(1,3)

—

骨節(jié)段

型組

亞組·12223242ABC骨干A=簡單B=楔形C=粉碎—.骨節(jié)段型組亞組關(guān)節(jié)周圍A

=關(guān)節(jié)外B=部分關(guān)節(jié)C

=完全關(guān)節(jié)—.骨節(jié)段型組亞組肱骨近端11-A=關(guān)節(jié)外，1部分B=關(guān)節(jié)外，2部分C=關(guān)節(jié)內(nèi)股骨近端31-A=粗隆B=頸骨折C=頭骨折11

AC31B踝關(guān)節(jié)44-A=下脛腓聯(lián)合遠(yuǎn)端B=經(jīng)下脛腓聯(lián)合C=下脛腓聯(lián)合遠(yuǎn)端ABC—.骨節(jié)段

型組亞組隨嚴(yán)重程度數(shù)字增大KeyPointsDisplacementofFragmentsAngulationlateralshortenedsegregatedrotationClassificationoffracturesaccordingtothedegreeandshapeoffracturesIncompleteCompleteStableunstalbe※ClinicalfindingsoffracturesLocalsignsThesystemicresponseRadiographicsignsThesystemicresponseShock

hemorrhagicshock（5210804）

multifractures,pelvic,femoralandopenfractures

traumaticshocksofttissue,pain,visceralinjuriesFeverabsorptionofhematoma＜38℃Openfractureswithinfection＞38℃5210804Localsigns

Generalfindings：

Pain,tenderness,swelling,ecchymosis,Lossoffunction

Characteristicsignsoffracture：※DeformityAbnormalmovementCrepitus

Thedefinitediagnosisoffracturecanbemadeifoneofthethreecharacteristicsisfound,andtheremaybeafractureevennoneofthemisfound.

DeformityTheRadiological

signsToconfirmthediagnosisToconfirmthefracturetypeandthedisplacementofthefragmentsAnterior-posteriorpositionshouldcoveratleastonejointTakex-rayagain2weekslaterifnecessaryCTinpelvis,hip,spinefracturesMRIinspineandkneeinjuries

TheDiagnosisofFractures

4“W”questionsmustbeansweredWhetheranyseverecomplicationhasdeveloped,shock,visceralinjury,majorarteryornerveinjury?Whichboneisfractured?Whereisbroken?Whatkind?

ClinicalfindingsoffracturesThesystemicresponse：shock,feverLocalsigns

GeneralfindingsPainandlocalizedtendernessSwellingandecchymosisLossoffunctionCharacteristicsignsoffractureDeformityAbnormalmovementCrepitusTheRadiological

signsThefracturehealingprocessTheclinicalstandardsforfracturehealing

ThefracturehealingprocessThefracturehealingprocess

MetaplasiaofhematomaFormationofprimarycallusRemodelingofcallus

Metaplasiaofhematoma

FormationofprimarycallusEndochondralossification,intramembranousossification

RemodelingofcallusWolff定律：隨著肢體的活動和負(fù)重，應(yīng)力軸線上的骨痂得到加強，骨小梁排列逐漸規(guī)則致密，應(yīng)力軸線以外的骨痂逐步被清除。骨小梁沿著應(yīng)力方向排列。即骨折的愈合總是沿著骨斷端承受的生理壓應(yīng)力方向生長。GrowthFactorswhichenhances

fracturehealing

BMPbonemorphogeneticproteinTGF-βtransforminggrowthfactorβIGFInsulin-likegrowthfactorFGFfibroblastgrowthfactorPDGFplatelet-derivedgrowthfactorEGFepidermaticgrowthfactorEssentialfactorsoffracturehealingMicromotionBloodsupplyStressTwoformsoffracturehealingPrimaryhealingHarversiansystemSecondaryhealingInternalcallusExternalcallusTheclinicalstandardsforfracturehealing

NolocalizedtendernessandaxialknockingpainNoabnormalmovementX-ray:continuouscallus，blurredfracturelineUpperextremitiescanstretchforwardwith1kgweightfor1minutesLowerextremitiescanwalkcontinuouslyfor3minutesandatleast30stepsFollowupfor2weeksandnoabn