Deng-Fx-2013

•
Infection of Bon来自 and Joint•
Post-Traumatic Ossification
•
Osteoarthritis
•
Joint Stiffness
On the basis of stability
stable fracture
unstable fracture
AO/ASIF CLASSIFICATION
AO (Arbeitsgemeinschaft fur Osteosynthesefragen) ASIF (Association for the Study of Internal Fixation)
Clinical findings and imaging studies Treatment Healing Process and the affecting factors Prognosis
CLINICAL & RADIOLOGICAL FEATURES
• Systemic Manifestations
邓忠良
Department of Orthopaedics Second Affiliated Hospital Chongqing Medical University
Bone Fracture
Definition Causes Classification Emergency care
Clinical findings and imageology examination Treatment Healing process and the affecting factors Prognosis
Location + type + subtype + group
骨折的AO分型
12-A1
4. Emergency care of fractures
Rescue the life
ABCDEF steps
(Mc Murtry 1980)
A
Air way and breathing
B
Bleeding and circulation
• Primary Shock ( Neurogenic Shock )
• Secondary Shock
•
Haemorrhage
• Notice : exclude to cerebral injury
•
and respiratory embarrassment
•
CLINICAL & RADIOLOGICAL FEATURES
•
Bony Crepitus or Grating
CLINICAL & RADIOLOGICAL FEATURES
•
Imageology Examination
• Fracture
yes or no ?
• Pattern of fracture
• Decide the Treatment Methods
唐代蔺道人“仙授理伤续断秘方”： 骨折治疗四大原则：
复位、固定、内外用药、功能锻炼
明代杨清叟
止血带：绢袋
清代江考鲫
骨移植：以别骨填接
古希腊Hippocrates（Bc460～377） 骨折脱位等的治疗 古罗马Galen（Ac130～200） 人体解剖 16世纪Azeecs 人 骨不连内固定治疗：木片
Trauma
Direct force Indirect force Muscular contraction force
Cyclic force
Bone diseases Localized diseases
—tubercular osteomyelitis, osteosarcoma, localized metastatic carcinoma, etc.
Open fracture
3. Classification of fractures
On the basis of aetiology On the basis of relationship with external environment On the basis of pattern
Transverse
1. DEFINITION OF FRACTURE
A fracture is a break in the continuity of a bone
2. Causes of fractures
Direct force
Trauma
Direct force causes the fracture
2. Causes of fractures
fracture caused by muscular contraction
2. Causes of fractures
Trauma
Direct force Indirect force Muscular contraction force
Cyclic force
2. Causes of fractures
rolling
lifting Two methods to transport the spine fracture
False method to transport the spine fracture
Fracture
Definition Causes Classification Emergency care
现代骨科及相关组织 AASOS
骨科
Creative , Innovation 需要创造性
相关学科的发展 Multiidiciplines development
Orthopaedics
INTRODUCTION OF FRACTURE
Zhong-Liang Deng Prof., MD, Ph.D
Trauma
Direct force Indirect force
Indirect force causes the fracture
2. Causes of fractures
Trauma
Direct force Indirect force Muscular contraction force
一、古代骨科简述
周朝（BC1100～770）
伤骨科（疡医科：折、疡之分）
春秋战国时期（皇帝内经） 截肢术（脱痈）
汉代华佗（AC147～207） 骨折复位、夹板固定，清创术，
“麻沸散” ：手术无痛原则
晋代葛洪（AC261～347） 竹夹板外固定骨折
隋代巢元方（AC581～618） 骨折内固定：线连接碎骨
• Late Complications
• Systemic Complication
•
Pressure Sores (bedsore)
•
Pneumonia
•
Infection of the Urinary tract
COMPLICATION OF FRACTURE
• Local Complications
On the basis of time
fresh fracture old fracture
Within 3 wks over 3 wks
3. Classification of fractures
On the basis of aetiology On the basis of relationship with external environment On the basis of pattern On the basis of displacements On the basis of time
C
Central nerve system
D
Digestive system
E
Excretion
F
Fracture
4. Emergency care of fractures
Preserve the life Manage the wound
4. Emergency care of fractures
Generalized diseases
—osteoporosis, multiple myeloma, diffuse metaststic carcinoma, etc.
3. Classification of fractures
On the basis of etiology
Traumatic fracture Pathological fracture
Preserve the life Manage the wound Immobilize the fracture
4. Emergency care of fractures
Preserve the life Manage the wound Immobilize the fracture Transfer the patient
Oblique
Spiral
“T” fracture Comminuted
3. Classification of fractures
On the basis of aetiology On the basis of relationship with external environment On the basis of pattern On the basis of displacements
COMPLICATION OF FRACTURE
• Early Complications
• Shock • Fat embolism • Injury to Important Organ and Tissue • Osteofascial Compartment Syndrome
COMPLICATION OF FRACTURE
•
Local Manifestation
•
•
Swelling
Traumatic Inflammation Pain
•
Impairment of
function
CLINICAL & RADIOLOGICAL FEATURES
• • • • Specific Signs
Deformity Abnormal Motion
Traumatic fracture
Pathological fracture
3. Classification of fractures
On the basis of etiology On the basis of relationship with external environment
Closed fracture Open fracture
Movement system(Orthopaedics) is composed with spine, extremities, bone, joint, muscles, vessels, nerves, lymph, fascia, synovium, etc.
Orthopaedics named in 1741
Undisplaced fracture
No significant displacement fractures
Displaced fracture
angulation
shift
overlap
gap
Different sorts of displaced fractures
rotation
Factors responsible for displacements
The fracturing force The muscle pull on the fracture fragments The gravity Incorrect medical care
3. Classification of fractures
On the basis of aetiology On the basis of relationship with external environment On the basis of pattern On the basis of displacements
Nicholas Andry coined the word. Orthos: correct, straight. Paedion: child
Jean-Andre Venel(1740-1791): Venevese, be called the Father of Orthopaedics
Plaster cast of Paris 1751